Hu Guofu, Jin Bi, Zheng Hong, Lai Chuanshan, Ouyang Chenxi, Xia Yin, Dang Yiping, Li Yiqing, Hu Guofu
Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
J Huazhong Univ Sci Technolog Med Sci. 2011 Feb;31(1):107-113. doi: 10.1007/s11596-011-0160-6. Epub 2011 Feb 19.
The general characteristics, outcomes and risk factors of the patients with aortic dissection (AD) were evaluated in a single medical center. From January 2002 to December 2008, 284 patients with AD were treated and followed-up at our institution, including 105 cases of type A AD and 179 cases of type B AD. The patients in each type were divided into three groups according to management: medical treatment group (A or B), open surgery group (A or B), and stent-graft group (A or B). The characteristics and follow-up outcomes were compared between the groups or subgroups. The results showed that there was significant difference in the prognosis for type A AD between medical treatment group and open surgery group, but there was no significant difference in the prognosis for type B AD between medical treatment group and stent-graft group. Independent risk factors of follow-up mortality for patients with type A AD included a history of atherosclerosis (HR, 3.807; 95% confidence interval [CI], 1.489 to 7.611; P=0.003), in-hospital hypotension/shock (HR, 4.687; 95% CI, 1.846 to 11.900; P=0.001), in-hospital myocardial ischemia or infarction (HR, 3.734; 95% CI, 1.613 to 8.643; P=0.002), pleural effusion (HR, 2.210; 95% CI, 1.080 to 4.521; P=0.030), branch vessel involvement (HR, 2.747; 95% CI, 1.202 to 6.278; P=0.016) and surgical treatment (HR, 0.177; 95% CI, 0.063 to 0.502; P=0.001). And there were insignificant independent predictors for mortality of the patients with type B AD. It was concluded that there were significant differences in characteristics and one year mortality between type A AD and type B AD, but after one year, there was no significant difference in the mortality and complications of them. There were several discordant risk factors of AD, such as female gender, age, thrombus, abrupt onset of pain that were considered as the risk factors in some papers. And there was no definite risk factor of mortality in this study in the patients with type B AD.
在单一医疗中心对主动脉夹层（AD）患者的一般特征、治疗结果及风险因素进行了评估。2002年1月至2008年12月，我院共收治并随访了284例AD患者，其中A型AD 105例，B型AD 179例。每种类型的患者根据治疗方式分为三组：药物治疗组（A或B型）、开放手术组（A或B型）和支架植入组（A或B型）。对各分组或亚组的特征及随访结果进行了比较。结果显示，药物治疗组与开放手术组治疗A型AD的预后存在显著差异，但药物治疗组与支架植入组治疗B型AD的预后无显著差异。A型AD患者随访死亡的独立危险因素包括动脉粥样硬化病史（HR，3.807；95%置信区间[CI]，1.489至7.611；P = 0.003）、住院期间低血压/休克（HR，4.687；95% CI，1.846至11.900；P = 0.001）、住院期间心肌缺血或梗死（HR，3.734；95% CI，1.613至8.643；P = 0.002）、胸腔积液（HR，2.210；95% CI，1.080至4.521；P = 0.030）、分支血管受累（HR，2.747；95% CI，1.202至6.278；P = 0.016）及手术治疗（HR，0.177；95% CI，0.063至0.502；P = 0.001）。而B型AD患者死亡的独立预测因素不显著。研究得出结论，A型AD和B型AD在特征及1年死亡率方面存在显著差异，但1年后，两者在死亡率及并发症方面无显著差异。AD存在一些不一致的风险因素，如女性、年龄、血栓、疼痛突然发作等，在一些文献中被视为风险因素。本研究中B型AD患者无明确的死亡危险因素。
