Sakakura Kenichi, Kubo Norifumi, Ako Junya, Ikeda Nahoko, Funayama Hiroshi, Hirahara Taishi, Sugawara Yoshitaka, Yasu Takanori, Kawakami Masanobu, Momomura Shinichi
Division of Cardiovascular Medicine, Department of Integrated Medicine I, Jichi Medical University, Omiya Medical Center, Omiya, Japan.
Circ J. 2007 Oct;71(10):1521-4. doi: 10.1253/circj.71.1521.
In Stanford B acute aortic dissection (AAD), medical treatment is the choice of therapy in the acute phase, however, a portion of patients experience complications caused by serious clinical outcomes including aortic rupture and abdominal visceral ischemia. The objective of this study was to determine the predictors of in-hospital events in an Asian cohort of Stanford type B AAD.
Hospital records were queried to identify patients that met following criteria: (1) AAD presenting within 14 days of symptom onset; and (2) computed tomography (CT) confirmation of a dissected descending aorta not involving the ascending aorta. An in-hospital event was defined as death, rupture/impending rupture, or organ malperfusion. Patient characteristics, inflammatory markers, and CT findings were obtained from clinical case records and retrospectively analyzed. Two hundred and twenty patients with Stanford B AAD were identified. In-hospital events occurred in 15 patients (there were 8 deaths, and 5 patients need to undergo emergent surgery because of impending rupture or rupture, and 4 patients experienced organ malperfusion). In univariate logistic regression analysis, the non-thrombosed type (odds ratio (OR) 3.88, 95% confidence interval (CI) 1.20-12.61, p=0.02) and maximum aortic diameter measured by an initial CT (each having a 5 mm increment: OR 1.61, 95% CI 1.20-2.15, p=0.001) were significant predictors of in-hospital events. In multiple logistic regression analysis, the only significant predictor was maximum aortic diameter measured by an initial CT (each having a 5 mm increment: OR 1.41, 95% CI 1.04-1.92, p=0.03).
The results identified a large maximum aortic diameter as the independent predictor of in-hospital events in Stanford type B AAD. The non-thrombosed type might also help differentiate high-risk patients.
在斯坦福B型急性主动脉夹层（AAD）中，急性期的治疗选择是药物治疗，然而，一部分患者会出现由严重临床结局引起的并发症，包括主动脉破裂和腹部脏器缺血。本研究的目的是确定亚洲斯坦福B型AAD队列中院内事件的预测因素。
查询医院记录以识别符合以下标准的患者：（1）症状发作后14天内出现AAD；（2）计算机断层扫描（CT）证实降主动脉夹层未累及升主动脉。院内事件定义为死亡、破裂/即将破裂或器官灌注不良。从临床病例记录中获取患者特征、炎症标志物和CT检查结果，并进行回顾性分析。共识别出220例斯坦福B型AAD患者。15例患者发生了院内事件（8例死亡，5例因即将破裂或已破裂而需要紧急手术，4例出现器官灌注不良）。在单因素逻辑回归分析中，非血栓形成型（比值比（OR）3.88，95%置信区间（CI）1.20-12.61，p=0.02）和初次CT测量的最大主动脉直径（每次增加5mm：OR 1.61，95%CI 1.20-2.15，p=0.001）是院内事件的显著预测因素。在多因素逻辑回归分析中，唯一显著的预测因素是初次CT测量的最大主动脉直径（每次增加5mm：OR 1.41，95%CI 1.04-1.92，p=0.03）。
结果表明，最大主动脉直径是斯坦福B型AAD院内事件的独立预测因素。非血栓形成型也可能有助于区分高危患者。
