Yu Hsi-Yu, Chen Yih-Sharng, Huang Shu-Chien, Wang Shoei-Shen, Lin Fang-Yue
Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7 Chung-Shan South Road, Taipei 100, Taiwan, ROC.
Eur J Cardiothorac Surg. 2004 May;25(5):683-90. doi: 10.1016/j.ejcts.2003.12.041.
The incidence of late mortality and morbidity of aortic dissection remained unchanged during the past 20 years. The present study was to analyze the risk factors of late events for patients with aortic dissection.
A total of 5654 cases of aortic dissection (3871 males) were collected from the National Health Insurance Databases from 1996 to 2001. Age, gender, Marfan syndrome, and initial treatment modality were the main factors to be investigated. Corrective group was defined by surgical operation with cardiopulmonary bypass and palliative group for the remaining. Late aortic events were defined by late aneurysmal evolution of diseased aorta needing surgical intervention or death of aortic causes from 6 months to 6 years.
The incidence of aortic dissection was 43 per 1000000 population in our country. Corrective group accounted for 19.3% of them and palliative group for 80.7%. Marfan syndrome accounted for 1.5% of all cases (4.3% of corrective surgery group). The rate of freedom from mortality at 1, 6 months, and 6 years was 80.4+/-1.3, 69.0+/-1.5, and 56.5+/-2.9% for corrective group and 89.5+/-0.5, 78.4+/-0.6, and 46.1+/-1.35% for palliative group. Nearly half of the late mortalities were attributed to atherosclerosis-related conditions (cardiac, stroke, or aortic causes). The incidence of late aortic events was 2.48% per year on an average, comparable between corrective and palliative groups. This incidence increased since the fourth year after their initial episode. For corrective group, young age was a risk factor of late aortic events (relative risk of 0.60-0.82 per decade, P = 0.037). For palliative group, Marfan syndrome and male gender were risk factors of late aortic events (relative risk of 4.08-10.7, P < 0.001 in the former; relative risk of 1.46-2.1, P = 0.002 in the latter).
Late aortic events were not uncommon for both corrective and palliative groups, and its incidence increased since the fourth year after their initial episodes. Young age for corrective group, Marfan syndrome and male gender for palliative group were risk factors of late aortic events.
在过去20年中，主动脉夹层的晚期死亡率和发病率保持不变。本研究旨在分析主动脉夹层患者晚期事件的危险因素。
从1996年至2001年的国民健康保险数据库中收集了总共5654例主动脉夹层病例（男性3871例）。年龄、性别、马凡综合征和初始治疗方式是主要研究因素。矫正组定义为接受体外循环手术的患者，其余为姑息治疗组。晚期主动脉事件定义为患病主动脉在6个月至6年期间出现需要手术干预的晚期动脉瘤进展或因主动脉原因死亡。
我国主动脉夹层的发病率为每100万人中有43例。矫正组占其中的19.3%，姑息治疗组占80.7%。马凡综合征占所有病例的1.5%（矫正手术组的4.3%）。矫正组在1个月、6个月和6年时的无死亡率分别为80.4±1.3%、69.0±1.5%和56.5±2.9%，姑息治疗组分别为89.5±0.5%、78.4±0.6%和46.1±1.35%。近一半的晚期死亡归因于动脉粥样硬化相关疾病（心脏、中风或主动脉原因）。晚期主动脉事件的平均年发病率为2.48%，矫正组和姑息治疗组相当。自初次发病后第四年起，这一发病率有所上升。对于矫正组，年轻是晚期主动脉事件的危险因素（每十年相对风险为0.60 - 0.82，P = 0.037）。对于姑息治疗组，马凡综合征和男性性别是晚期主动脉事件的危险因素（前者相对风险为4.08 - 10.7，P < 0.001；后者相对风险为1.46 - 2.1，P = 0.002）。
矫正组和姑息治疗组的晚期主动脉事件均并不罕见，且自初次发病后第四年起其发病率有所上升。矫正组的年轻、姑息治疗组的马凡综合征和男性性别是晚期主动脉事件的危险因素。
