B型主动脉壁内血肿患者临床及形态学表现的预后价值
Prognostic value of clinical and morphologic findings in patients with type B aortic intramural hematoma.
作者信息
Li Zilun, Liu Chenshu, Wu Ridong, Zhang Jian, Pan Hong, Tan Jinghong, Guo Zhuang, Guo Yingying, Yu Nan, Yao Chen, Chang Guangqi
机构信息
Division of Vascular Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
出版信息
J Cardiothorac Surg. 2020 Mar 23;15(1):49. doi: 10.1186/s13019-020-1067-8.
BACKGROUND
Aortic intramural hematoma (IMH) is a subset of acute aortic syndrome, and its prognosis may differ between races. This study aimed to study the prognosis of Chinese type B IMH patients and to find out risk factors.
METHODS
A total of 71 type B IMH patients with or without penetrating atherosclerosis ulcer (PAU) administrated in our center between September 2013 and October 2017 were retrospectively studied. Both clinical and imaging data were collected and analyzed. The primary end point was aorta-related death, and the secondary end point was progression, which was defined as enlargement of aorta, increased aortic wall thickness, and aortic dissection or aneurysm formation. Kaplan-Meier survival analysis and Cox regression analysis were used for prognostic analysis.
RESULTS
Among these 71 patients, 21 had simple type B IMH, when 50 had type B IMH in association with PAU. Twenty-five patients received optimal medical therapy (OMT) alone, while 46 patients received surgery and OMT. The mean follow-up time was 27.5 ± 13.5 months. For type B IMH patients, association with PAU indicated poor prognosis and required more intensive management (HR = 16.68, 1.96141.87), while maximum aortic diameter (MAD) was an independent risk factor (HR = 1.096, 1.0161.182). For patients with PAU-IMH, MAD was an independent risk factor (HR = 1.04, 1.0211.194), while surgical treatment was independent protective factor (HR = 0.172, 0.0420.696).
CONCLUSION
Association with PAU and MAD were independent risk factors for type B IMH patients. Surgery may improve the outcomes for type B IMH in association with PAU.
背景
主动脉壁内血肿（IMH）是急性主动脉综合征的一个亚型，其预后在不同种族间可能存在差异。本研究旨在探讨中国B型IMH患者的预后并找出危险因素。
方法
回顾性研究了2013年9月至2017年10月期间在本中心接受治疗的71例伴有或不伴有穿透性动脉粥样硬化溃疡（PAU）的B型IMH患者。收集并分析了临床和影像学数据。主要终点是主动脉相关死亡，次要终点是病情进展，定义为主动脉增粗、主动脉壁厚度增加以及主动脉夹层或动脉瘤形成。采用Kaplan-Meier生存分析和Cox回归分析进行预后分析。
结果
在这71例患者中，21例为单纯B型IMH，50例为合并PAU的B型IMH。25例患者仅接受了最佳药物治疗（OMT），46例患者接受了手术及OMT。平均随访时间为27.5±13.5个月。对于B型IMH患者，合并PAU提示预后不良且需要更积极的治疗（HR = 16.68，1.96141.87），而主动脉最大直径（MAD）是一个独立危险因素（HR = 1.096，1.0161.182）。对于PAU-IMH患者，MAD是一个独立危险因素（HR = 1.04，1.021~1.194），而手术治疗是独立保护因素（HR = 0.172，0.
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