Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, PR China; Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University Changji Sorting, Changji, 831100, PR China.
Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, PR China.
Heart Lung Circ. 2019 Aug;28(8):1261-1266. doi: 10.1016/j.hlc.2018.07.002. Epub 2018 Jul 25.
Renal artery involvement has not received sufficient attention despite the fact that aortic computed tomography angiography (CTA) examinations of Stanford B-type aortic dissection patients usually show renal artery involvement [3]. To study the influence of renal artery involvement on aortic dissection, we performed a retrospective study on acute Stanford B-type aortic dissection patients with or without renal artery involvement to investigate its effect on the prognosis of aortic dissection.
A total of 221 patients with acute Stanford-B type aortic dissection between January 2012 and January 2014 were enrolled. The patients were divided into a renal artery involvement group and a non-renal artery involvement group based on aortic computed tomography angiography (CTA) results. The clinical data of the two groups were compared. Univariate analyses and multiple logistic regression analyses were performed to determine risk factors related to in-hospital mortality. The effect of renal artery involvement on the prognosis of Stanford B-type aortic dissection patients was analysed.
Among the 221 patients with acute Stanford type-B aortic dissection, 100 patients (45.2%) exhibited renal artery involvement. The percentage of patients with a past history of hypertension in the renal artery involvement group was significantly higher than that in the non-renal artery involvement group (84.0% vs. 74.8%, p=0.025). The estimated glomerular filtration rate (eGFR), creatinine level, and urea nitrogen level at admission were not significantly different between the renal artery involvement group and the non-renal artery involvement group. The in-hospital mortality rate in the renal artery involvement group was higher than that in the non-renal artery involvement group; the difference in the percentage of in-hospital mortality between these two groups was statistically significant (12.0% vs. 4.1%, p<0.05). The results of multiple logistic regression analysis showed that renal artery involvement was a risk factor for in-hospital mortality in acute Stanford B-type aortic dissection patients (odds ratio (OR)=3.536 (1.127∼11.095)). In the renal artery involvement group, the in-hospital mortality rate in the conservative treatment group was significantly higher than that in the interventional treatment group (30.8% vs. 5.4%, p=0.001).
Although renal artery involvement was not associated with short-term renal function damage, it was a risk factor for in-hospital mortality after acute Stanford B-type aortic dissection.
尽管斯坦福 B 型主动脉夹层患者的主动脉计算机断层血管造影（CTA）检查通常显示肾动脉受累，但肾动脉受累并未受到足够重视。为了研究肾动脉受累对主动脉夹层的影响，我们对有或无肾动脉受累的急性 Stanford B 型主动脉夹层患者进行了回顾性研究，以探讨其对主动脉夹层预后的影响。
纳入 2012 年 1 月至 2014 年 1 月期间 221 例急性 Stanford-B 型主动脉夹层患者，根据主动脉 CTA 结果将患者分为肾动脉受累组和非肾动脉受累组，比较两组患者的临床资料。采用单因素分析和多因素 logistic 回归分析确定与院内死亡相关的危险因素，分析肾动脉受累对 Stanford B 型主动脉夹层患者预后的影响。
在 221 例急性 Stanford 型 B 型主动脉夹层患者中，100 例（45.2%）存在肾动脉受累。肾动脉受累组患者中既往有高血压病史的比例明显高于非肾动脉受累组（84.0%比 74.8%，p=0.025）。肾动脉受累组与非肾动脉受累组患者入院时估算肾小球滤过率（eGFR）、血肌酐、血尿素氮水平无显著差异。肾动脉受累组患者院内死亡率高于非肾动脉受累组，两组患者院内死亡率差异有统计学意义（12.0%比 4.1%，p<0.05）。多因素 logistic 回归分析结果显示，肾动脉受累是急性 Stanford B 型主动脉夹层患者院内死亡的危险因素（比值比（OR）=3.536（1.127∼11.095））。在肾动脉受累组中，保守治疗组患者的院内死亡率明显高于介入治疗组（30.8%比 5.4%，p=0.001）。
尽管肾动脉受累与短期肾功能损害无关，但它是急性 Stanford B 型主动脉夹层患者院内死亡的危险因素。
