Yang Kun-Qi, Yang Yan-Kun, Meng Xu, Zhang Ying, Zhang Hui-Min, Wu Hai-Ying, Liu Ya-Xin, Jiang Xiong-Jing, Cai Jun, Zhou Xian-Liang, Hui Ru-Tai, Zheng De-Yu, Liu Li-Sheng
Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Am J Med Sci. 2017 Apr;353(4):342-352. doi: 10.1016/j.amjms.2017.01.010. Epub 2017 Jan 21.
Aortic dissection (AD) is a rare complication of Takayasu arteritis (TA). The clinical presentation and long-term management outcomes of AD in patients with TA have not been well described.
We conducted a retrospective study of patients with TA along with AD admitted to Fuwai Hospital between January 1985 and March 2016. Clinical data and follow-up data were collected and analyzed.
Of the 1,154 patients with TA, we identified 10 patients (0.87%) with AD, which was likely to be associated with vasculitis. All patients were females with a median age at TA onset of 26.5 years (range: 18.3-33.3 years), had type III TA and had a history of hypertension, which was much more common than that in previously reported cases. Stanford type B or DeBakey category III was the dominant anatomic classification of AD. Four patients developed AD after the diagnosis of TA, and 6 developed AD near the time of TA diagnosis. Nine patients underwent conservative treatment, whereas 1 patient underwent endovascular repair due to extensive dissection. At a median 70.5-month follow-up (range: 31.5-138.5), we found that 7 patients had no AD progression, 1 patient had progressed without symptoms, 1 patient was lost and 1 patient died.
Patients with TA along with long-standing and poorly controlled hypertension are liable to develop AD. Those with extensive AD in TA should be carefully treated and intensively followed up.
主动脉夹层（AD）是大动脉炎（TA）的一种罕见并发症。TA患者AD的临床表现及长期治疗结果尚未得到充分描述。
我们对1985年1月至2016年3月期间入住阜外医院的TA合并AD患者进行了一项回顾性研究。收集并分析了临床资料和随访数据。
在1154例TA患者中，我们确定了10例（0.87%）合并AD的患者，这可能与血管炎有关。所有患者均为女性，TA发病的中位年龄为26.5岁（范围：18.3 - 33.3岁），患有III型TA，并有高血压病史，这比先前报道的病例更为常见。AD的主要解剖学分类为斯坦福B型或德巴基III型。4例患者在TA诊断后发生AD，6例在TA诊断时附近发生AD。9例患者接受了保守治疗，而1例患者因广泛夹层而接受了血管内修复。在中位70.5个月的随访（范围：31.5 - 138.5个月）中，我们发现7例患者AD无进展，1例患者无症状进展，1例患者失访，1例患者死亡。
TA合并长期高血压且控制不佳的患者易发生AD。TA合并广泛AD的患者应谨慎治疗并密切随访。
