Shimizu Toshikazu, Kimura Naoyuki, Mieno Makiko, Hori Daijiro, Shiraishi Manabu, Tashima Yasushi, Yuri Koichi, Itagaki Ryo, Aizawa Kei, Kawahito Koji, Yamaguchi Atsushi
Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University Saitama Japan.
Department of Medical Informatics, Center for Information, Jichi Medical University Shimotsuke Japan.
Circ Rep. 2020 Oct 23;2(11):639-647. doi: 10.1253/circrep.CR-20-0098.
The prevalence of obesity among Japanese acute type A aortic dissection (ATAAD) patients and its effect on repair outcomes remain to be elucidated. The prevalence of obesity (body mass index [BMI] ≥30.0 kg/m) among 1,059 patients (mean [±SD] age 64.3±12.7 years) who underwent ATAAD repair between 1990 and 2018 was compared with that among the general Japanese population (National Health and Nutrition Survey data). The prevalence of obesity among male patients (17.1% [6/35], 20.0% [18/90], and 14.4% [20/139] for those aged 20-39, 40-49, and 50-59 years, respectively) was significantly higher than that among the age- and sex-matched general population. The 1,059 patients were divided into groups according to weight (normal [BMI <25.0 kg/m; n=742], overweight [BMI 25.0-29.9 kg/m; n=248], or obese [BMI ≥30.0 kg/m; n=69]). Comparing the normal weight, overweight, and obese groups revealed significant differences among the 3 groups in median cardiopulmonary bypass time (143, 167, and 183 min, respectively), ventilation >48 h (44.5%, 60.1%, and 78.3%, respectively), and in-hospital mortality (7.0%, 7.3%, and 17.4%, respectively), but not in 30-day survival. Shock, visceral malperfusion, operation time >360 min, obesity, and coronary malperfusion were identified as predictors of in-hospital mortality. The prevalence of obesity is increased among Japanese male patients with ATAAD aged ≤59 years. Obesity may increase these patients' operative risk; overweight does not.
日本急性A型主动脉夹层（ATAAD）患者的肥胖患病率及其对修复结果的影响仍有待阐明。将1990年至2018年间接受ATAAD修复的1059例患者（平均[±标准差]年龄64.3±12.7岁）的肥胖患病率（体重指数[BMI]≥30.0kg/m²）与日本普通人群（国民健康与营养调查数据）进行比较。男性患者（20 - 39岁、40 - 49岁和50 - 59岁的肥胖患病率分别为17.1%[6/35]、20.0%[18/90]和14.4%[20/139]）显著高于年龄和性别匹配的普通人群。将这1059例患者按体重分为几组（正常体重[BMI <25.0kg/m²；n = 742]、超重[BMI 25.0 - 29.9kg/m²；n = 248]或肥胖[BMI≥30.0kg/m²；n = 69]）。对正常体重、超重和肥胖组进行比较发现，三组在体外循环中位时间（分别为143、167和183分钟）、通气>48小时（分别为44.5%、60.1%和78.3%）以及住院死亡率（分别为7.0%、7.3%和17.4%）方面存在显著差异，但在30天生存率方面无差异。休克、内脏灌注不良、手术时间>360分钟、肥胖和冠状动脉灌注不良被确定为住院死亡率的预测因素。≤59岁的日本男性ATAAD患者肥胖患病率增加。肥胖可能会增加这些患者的手术风险；超重则不会。
