CAJ | 학술논문

目的：了解当前国人急性主动脉夹层（AAD）的临床特征，以指导疾病诊断及治疗。方法收集2008年1月1日~2011年12月31日国内15家大型心脏中心经影像学检查确诊AAD患者1812例（其中Stanford A型726例，Stanford B型1086例）的临床资料。研究内容包括人口学特征、合并症、临床表现、诊断、治疗、预后及随访等情况，并比较Stanford A型与B型夹层患者之间临床特征的差别。结果患者平均年龄为（51.1±10.9）岁，男女比例约为3.44：1。Stanford B型AAD患者的平均年龄大于A型AAD患者[（53.3±10.1）vs.（47.5±11.2），P＜0.001]，Stanford A型AAD患者男性比例较B型更高（83.7%vs.73.3%，P＜0.001）。B型AAD患者中，86.8%患者合并高血压病，22.0%患者合并动脉粥样硬化，49.5%患者吸烟，均高于A型夹层患者（P＜0.05）。A型AAD患者中，32.5%患者合并马凡综合征，19.1%患者合并主动脉瓣二瓣化畸形，均明显高于B型AAD患者（P＜0.01）。A型AAD患者有疼痛表现占89.4%，其中前胸痛76.3%，迁移痛12.3%；B型AAD患者中背痛占73.8%，腹痛14.2%。76.3% AAD患者采用CT检查确定诊断。75.3% A型AAD患者实施了外科手术治疗，死亡率为15.9%；76.1%B型AAD患者实施了血管内介入治疗，术后发生内漏占7.8%，死亡率为0.6%。Cox住院死亡风险显示，合并高血压病发生AAD的风险度（HR）为2.80、合并马凡综合征HR为1.76。结论与Stanford B型AAD比较，A型AAD患者发病年龄较轻，且男性比例较高。B型AAD患者多合并高血压、动脉粥样硬化和吸烟，A型AAD患者多合并马凡综合征和主动脉瓣二瓣化畸形多见。疼痛是主要的临床表现，CT检查是最常用的确定诊断方法。
목적：료해당전국인급성주동맥협층（AAD）적림상특정，이지도질병진단급치료。방법수집2008년1월1일~2011년12월31일국내15가대형심장중심경영상학검사학진AAD환자1812례（기중Stanford A형726례，Stanford B형1086례）적림상자료。연구내용포괄인구학특정、합병증、림상표현、진단、치료、예후급수방등정황，병비교Stanford A형여B형협층환자지간림상특정적차별。결과환자평균년령위（51.1±10.9）세，남녀비례약위3.44：1。Stanford B형AAD환자적평균년령대우A형AAD환자[（53.3±10.1）vs.（47.5±11.2），P＜0.001]，Stanford A형AAD환자남성비례교B형경고（83.7%vs.73.3%，P＜0.001）。B형AAD환자중，86.8%환자합병고혈압병，22.0%환자합병동맥죽양경화，49.5%환자흡연，균고우A형협층환자（P＜0.05）。A형AAD환자중，32.5%환자합병마범종합정，19.1%환자합병주동맥판이판화기형，균명현고우B형AAD환자（P＜0.01）。A형AAD환자유동통표현점89.4%，기중전흉통76.3%，천이통12.3%；B형AAD환자중배통점73.8%，복통14.2%。76.3% AAD환자채용CT검사학정진단。75.3% A형AAD환자실시료외과수술치료，사망솔위15.9%；76.1%B형AAD환자실시료혈관내개입치료，술후발생내루점7.8%，사망솔위0.6%。Cox주원사망풍험현시，합병고혈압병발생AAD적풍험도（HR）위2.80、합병마범종합정HR위1.76。결론여Stanford B형AAD비교，A형AAD환자발병년령교경，차남성비례교고。B형AAD환자다합병고혈압、동맥죽양경화화흡연，A형AAD환자다합병마범종합정화주동맥판이판화기형다견。동통시주요적림상표현，CT검사시최상용적학정진단방법。
Objective To investigate the clinical characteristics of acute aortic dissection (AAD) in Chinese people for guiding diagnosis and treatment.Methods The clinical data were collected from 1812 patients with AAD diagnosed with imageological examinations [726 with Stanford type A AAD (group A) and 1086 with Stanford type B AAD (group B)] from 15 large heart centers from Jan. 1, 2008 to Dec. 31, 2011. The study content included demographic characteristics, complications, clinical manifestations, diagnosis, treatment, prognosis and follow-up. The difference in clinical characteristics was compared between two groups.Results The average age was (51.1± 10.9), and ratio of male to female was 3.44 to 1. The average age was higher in group B than that in group A [(53.3 ±10.1)vs. (47.5±11.2),P<0.001]. The percentage of male patients was higher in group A than that in group B (83.7%vs. 73.3%,P<0.001). In group B, 86.8% patients had hypertension, 22.0% had atherosclerosis and 49.5%had smoking history, and all of them were higher than those in group A (P<0.05). In group A, 32.5% had Marfan syndrome and 19.1% patients had bicuspid aortic valve, and all of them were significantly higher than those in group B (P<0.01). In group A, 89.4% patients had pain symptoms, among them 76.3% had anterior chest pain and 12.3%had migration pain. In group B, 73.8% patients had back pain and 14.2% had abdominal pain. The patients with CT scan for confirming diagnosis accounted for 76.3%. In group A, 75.3% patients had surgical therapies and mortality was 15.9%. In group B, 76.1% patients had intravascular intervention, 7.8% had postoperative endoleak and mortality was 0.6%. Cox hospitalization risk analysis showed that the hazard rate (HR) of complicating hypertension was 2.80, and HR of complicating Marfan syndrome was 1.76.Conclusion Compared with group B, the age of AAD attack is lower and male percentage is higher in group A. The most of patients in group B have complicating hypertension and atherosclerosis and smoking history, and most of those in group A have complicating Marfan syndrome and bicuspid aortic valve. Pain is main clinical manifestation and CT scan is the most common method for confirming diagnosis.