Olsson Christian, Eriksson Per, Franco-Cereceda Anders
Cardiovascular Surgery Unit, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden (C.O., A.F.C.).
Atherosclerosis Research Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden (P.E.).
J Am Heart Assoc. 2014 Aug 21;3(4):e001040. doi: 10.1161/JAHA.114.001040.
The study hypothesis was that thoracic aortic disease (TAD) is associated with a higher-than-expected prevalence of inguinal hernia. Such an association has been reported for abdominal aortic aneurysm (AAA) and hernia. Unlike AAA, TAD is not necessarily detectable with clinical examination or ultrasound, and there are no population-based screening programs for TAD. Therefore, conditions associated with TAD, such as inguinal hernia, are of particular clinical relevance.
The prevalence of inguinal hernia in subjects with TAD was determined from nation-wide register data and compared to a non-TAD group (patients with isolated aortic stenosis). Groups were balanced using propensity score matching. Multivariable statistical analysis (logistic regression) was performed to identify variables independently associated with hernia. Hernia prevalence was 110 of 750 (15%) in subjects with TAD versus 29 of 301 (9.6%) in non-TAD, P=0.03. This statistically significant difference remained after propensity score matching: 21 of 159 (13%) in TAD versus 14 of 159 (8.9%) in non-TAD, P<0.001. Variables independently associated with hernia in multivariable analysis were male sex (odds ratio [OR] with 95% confidence interval [95% CI]) 3.4 (2.1 to 5.4), P<0.001; increased age, OR 1.02/year (1.004 to 1.04), P=0.014; and TAD, OR 1.8 (1.1 to 2.8), P=0.015.
The prevalence of inguinal hernia (15%) in TAD is higher than expected in a general population and higher in TAD, compared to non-TAD. TAD is independently associated with hernia in multivariable analysis. Presence or history of hernia may be of importance in detecting TAD, and the association warrants further study.
本研究的假设是胸主动脉疾病（TAD）与腹股沟疝的患病率高于预期有关。腹主动脉瘤（AAA）与疝之间已报道存在这种关联。与AAA不同，TAD不一定能通过临床检查或超声检测到，并且没有针对TAD的基于人群的筛查项目。因此，与TAD相关的疾病，如腹股沟疝，具有特殊的临床意义。
从全国登记数据中确定TAD患者中腹股沟疝的患病率，并与非TAD组（孤立性主动脉瓣狭窄患者）进行比较。使用倾向评分匹配使两组达到平衡。进行多变量统计分析（逻辑回归）以确定与疝独立相关的变量。TAD患者中疝的患病率为750例中的110例（15%），而非TAD组为301例中的29例（9.6%），P = 0.03。倾向评分匹配后，这种统计学上的显著差异仍然存在：TAD组159例中有21例（13%），非TAD组159例中有14例（8.9%），P < 0.001。多变量分析中与疝独立相关的变量为男性（优势比[OR]及95%置信区间[95%CI]）3.4（2.1至5.4），P < 0.001；年龄增加，OR为每年1.02（1.004至1.04），P = 0.014；以及TAD，OR为1.8（1.1至2.8），P = 0.015。
TAD患者中腹股沟疝的患病率（15%）高于一般人群的预期，且与非TAD相比更高。在多变量分析中，TAD与疝独立相关。疝存在或有疝病史在检测TAD中可能具有重要意义，这种关联值得进一步研究。
