Masaki Naoki, Kumagai Kiichiro, Sasaki Konosuke, Matsuo Satoshi, Motoyoshi Naotaka, Adachi Osamu, Akiyama Masatoshi, Kawamoto Shunsuke, Tabayashi Koichi, Saiki Yoshikatsu
Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Seiryocho, Aoba-ku, Sendai, 980-8574, Japan.
Research Division of Sciences for Aortic Disease, Tohoku University Graduate School of Medicine, Sendai, Japan.
Gen Thorac Cardiovasc Surg. 2018 Jun;66(6):334-343. doi: 10.1007/s11748-018-0916-z. Epub 2018 Apr 6.
Medical therapy for patients with uncomplicated acute type B aortic dissection (ABAD) is essentially accepted for its excellent early outcome; however, long-term outcomes have not been satisfactory due to aorta-related complications. This trial was performed to investigate the efficacy of a statin as an additive that may enhance the effectiveness of conventional medical treatment in patients with ABAD.
This was a multi-center, prospective, and randomized comparative investigation of patients with uncomplicated ABAD. Fifty patients with ABAD compatible with inclusion criteria were randomly assigned to two groups and then received administration of pitavastatin (group P) or not (group C). We followed up the patients for 1 year from study onset.
Two patients demised during the follow-up period (both were in group C). In addition, aorta-related interventions were performed in two patients (entry closure for aortic dissection by endovascular repair in one patient in each group). Aortic arch diameters at 1 year in group P tended to be smaller than in group C (P = 0.17), and the rate of change of the aortic arch diameters from onset to 1 year was significantly lower in group P (P = 0.046). Multivariate analysis identified patency of the false lumen was detected as a risk factor for aortic arch dilatation (P = 0.02), and pitavastatin intake was a negative risk factor (P = 0.03).
Pitavastatin treatment, in addition to the standard antihypertensive therapy, may have a suppressive effect on aortic arch dilatation in patients with ABAD.
对于无并发症的急性B型主动脉夹层（ABAD）患者，药物治疗因其出色的早期疗效已基本得到认可；然而，由于与主动脉相关的并发症，其长期疗效并不令人满意。本试验旨在研究他汀类药物作为一种添加剂的疗效，它可能会增强传统药物治疗对ABAD患者的有效性。
这是一项针对无并发症ABAD患者的多中心、前瞻性随机对照研究。50例符合纳入标准的ABAD患者被随机分为两组，然后分别接受匹伐他汀治疗（P组）或不接受治疗（C组）。从研究开始我们对患者进行了1年的随访。
随访期间有2例患者死亡（均在C组）。此外，两组各有1例患者接受了与主动脉相关的干预（1例患者通过血管内修复术封闭主动脉夹层入口）。P组1年时的主动脉弓直径趋于小于C组（P = 0.17），且P组从发病到1年的主动脉弓直径变化率显著更低（P = 0.046）。多因素分析确定假腔通畅是主动脉弓扩张的危险因素（P = 0.02），而服用匹伐他汀是负性危险因素（P = 0.03）。
除标准降压治疗外，匹伐他汀治疗可能对ABAD患者的主动脉弓扩张有抑制作用。
