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斯坦福B型主动脉夹层中的阻塞性睡眠呼吸暂停与多种与晚期主动脉事件相关的影像学征象有关。

Obstructive Sleep Apnoea in Stanford Type B Aortic Dissection Is Associated With Multiple Imaging Signs Related to Late Aortic Events.

作者信息

Zhang Jiawei, Zhang Zhe, Fu Lingyu, Wang Lei, Yang Yu, Wang Hao, Zhou Baosen, Wang Wei, Zhang Jian, Xin Shijie

机构信息

Department of Vascular Surgery, The First Hospital of China Medical University, Shenyang, China.

Department of Clinical Epidemiology and Evidence Medicine, The First Hospital of China Medical University, Shenyang, China.

出版信息

Front Cardiovasc Med. 2021 Nov 18;8:752763. doi: 10.3389/fcvm.2021.752763. eCollection 2021.

Abstract

Obstructive sleep apnoea (OSA) is highly prevalent in patients with Stanford type B aortic dissection (TBAD). Few studies have evaluated the effects of OSA on vascular changes in TBAD patients. This study aimed to explore the effect of OSA on aortic morphological changes in TBAD patients and its relation to late aortic events (LAEs). This case-control study included 143 TBAD patients. The diameters of different parts of the aorta were measured based on computed tomography angiography (CTA). According to the apnoea-hypopnoea index (AHI), OSA was classified as mild (5 ≤ AHI ≤ 15), moderate (15 < AHI ≤ 30), or severe (AHI > 30). The false lumen (FL) status was evaluated and classified as partially thrombosed, patent, or completely thrombosed. The OSA prevalence in TBAD patients was 64.3%, and image differences related to LAEs between TBAD patients with and without OSA included the maximum aortic diameter at onset (37.3 ± 3.9 vs. 40.3 ± 4.5 mm, < 0.001), the FL diameter of the proximal descending thoracic aorta (16.0 ± 6.8 vs. 20.3 ± 4.7 mm, < 0.001), and the proportion of the FL that was partially thrombosed (39.2 vs. 64.1%, = 0.004). Additionally, in the multivariable analysis of patients with OSA, the risks of an aortic diameter ≥40 mm, a proximal descending aorta FL ≥ 22 mm and a partially thrombosed FL were 4.611 (95% CI: 1.796-11.838, = 0.001), 2.544 (95% CI: 1.050-6.165, = 0.039), and 2.565 (95% CI: 1.167-5.637, = 0.019), respectively, after adjustment for confounding factors. Trend tests showed that the risks of an aortic diameter ≥40 mm and a partially thrombosed FL increased with increasing OSA severity. TBAD patients with moderate to severe OSA have aortic dilatation in different parts of the aorta. OSA is an independent risk factor for multiple imaging signs related to LAEs, suggesting that OSA is an important factor affecting the prognosis of TBAD patients.

摘要

阻塞性睡眠呼吸暂停(OSA)在斯坦福B型主动脉夹层(TBAD)患者中高度流行。很少有研究评估OSA对TBAD患者血管变化的影响。本研究旨在探讨OSA对TBAD患者主动脉形态变化的影响及其与晚期主动脉事件(LAEs)的关系。 这项病例对照研究纳入了143例TBAD患者。基于计算机断层扫描血管造影(CTA)测量主动脉不同部位的直径。根据呼吸暂停低通气指数(AHI),OSA被分为轻度(5≤AHI≤15)、中度(15<AHI≤30)或重度(AHI>30)。评估假腔(FL)状态并分为部分血栓形成、通畅或完全血栓形成。 TBAD患者中OSA的患病率为64.3%,有OSA和无OSA的TBAD患者之间与LAEs相关的影像差异包括发病时的最大主动脉直径(37.3±3.9 vs. 40.3±4.5mm,<0.001)、胸降主动脉近端的FL直径(16.0±6.8 vs. 20.3±4.7mm,<0.001)以及部分血栓形成的FL比例(39.2 vs. 64.1%,=0.004)。此外,在对OSA患者的多变量分析中,在调整混杂因素后,主动脉直径≥40mm、胸降主动脉近端FL≥22mm和部分血栓形成的FL的风险分别为4.611(95%CI:1.796 - 11.838,=0.001)、2.544(95%CI:1.050 - 6.165,=0.039)和2.565(95%CI:1.167 - 5.637,=0.019)。趋势检验表明,主动脉直径≥40mm和部分血栓形成的FL的风险随着OSA严重程度的增加而增加。 中度至重度OSA的TBAD患者在主动脉的不同部位存在主动脉扩张。OSA是与LAEs相关的多个影像征象的独立危险因素,提示OSA是影响TBAD患者预后的重要因素。

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