中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2012年
43期
3050-3053
,共4页
张晓宇%张健%夏茜%韩彦槊%刘志敏%王丰艺%辛世杰%段志泉
張曉宇%張健%夏茜%韓彥槊%劉誌敏%王豐藝%辛世傑%段誌泉
장효우%장건%하천%한언삭%류지민%왕봉예%신세걸%단지천
主动脉瘤,腹%贫血%预后%回顾性研究
主動脈瘤,腹%貧血%預後%迴顧性研究
주동맥류,복%빈혈%예후%회고성연구
Aortic aneurysm,abdominal%Anemia%Prognosis%Retrospective studies
目的 观察腹主动脉瘤(AAA)患者术前血红蛋白水平与AAA瘤体直径大小间的相关性及可能存在的对远期生存率的影响.方法 回顾性分析中国医科大学附属第一医院2002年1月至2012年6月收治的387例AAA患者的临床资料,经筛选后纳入研究范围AAA患者255例.患者分为3组(排除30 d内死亡20例),其中腔内修复(EVAR)组62例,开腹手术组76例,未手术组97例.正常血红蛋白水平按110 ～ 160 g/L计,按我国诊断标准,在海平面地区,男性＜120 g/L,女性(非妊娠)＜110 g/L认为贫血.患者平均随访时间(63 ±42)个月.应用多重线性回归方法研究患者血红蛋白水平与瘤体直径大小的关系,Kaplan-Meier生存曲线比较以上3组中贫血与非贫血患者生存率,COX比例风险回归模型分析患者预后.结果 共有88(34.5％)例术前或未手术患者合并贫血.在多重线性回归模型中纳入各种影响因素后,血红蛋白水平与腹主动脉瘤瘤体最大直径呈负相关(β=-0.152,P=0.017).经随访后,上述3组中贫血组患者5年生存率分别为56％、51％、42％,非贫血患者5年生存率分别为94％、90％、80％.贫血组患者生存率低于非贫血组患者(P=0.005,0.001,0.025).COX比例风险回归模型纳入各种影响因素后,血红蛋白水平与患者死亡相关,相对危险度分别为0.923、0.963、0.963;P值分别为0.001、0.002、0.028;95％CI分别为0.8798 ～ 0.970,0.941 ～0.986,0.932～0.996).结论 AAA患者血红蛋白水平为影响腹主动脉瘤直径的独立因素,贫血降低腹主动脉瘤患者的远期生存率.
目的 觀察腹主動脈瘤(AAA)患者術前血紅蛋白水平與AAA瘤體直徑大小間的相關性及可能存在的對遠期生存率的影響.方法 迴顧性分析中國醫科大學附屬第一醫院2002年1月至2012年6月收治的387例AAA患者的臨床資料,經篩選後納入研究範圍AAA患者255例.患者分為3組(排除30 d內死亡20例),其中腔內脩複(EVAR)組62例,開腹手術組76例,未手術組97例.正常血紅蛋白水平按110 ～ 160 g/L計,按我國診斷標準,在海平麵地區,男性＜120 g/L,女性(非妊娠)＜110 g/L認為貧血.患者平均隨訪時間(63 ±42)箇月.應用多重線性迴歸方法研究患者血紅蛋白水平與瘤體直徑大小的關繫,Kaplan-Meier生存麯線比較以上3組中貧血與非貧血患者生存率,COX比例風險迴歸模型分析患者預後.結果 共有88(34.5％)例術前或未手術患者閤併貧血.在多重線性迴歸模型中納入各種影響因素後,血紅蛋白水平與腹主動脈瘤瘤體最大直徑呈負相關(β=-0.152,P=0.017).經隨訪後,上述3組中貧血組患者5年生存率分彆為56％、51％、42％,非貧血患者5年生存率分彆為94％、90％、80％.貧血組患者生存率低于非貧血組患者(P=0.005,0.001,0.025).COX比例風險迴歸模型納入各種影響因素後,血紅蛋白水平與患者死亡相關,相對危險度分彆為0.923、0.963、0.963;P值分彆為0.001、0.002、0.028;95％CI分彆為0.8798 ～ 0.970,0.941 ～0.986,0.932～0.996).結論 AAA患者血紅蛋白水平為影響腹主動脈瘤直徑的獨立因素,貧血降低腹主動脈瘤患者的遠期生存率.
목적 관찰복주동맥류(AAA)환자술전혈홍단백수평여AAA류체직경대소간적상관성급가능존재적대원기생존솔적영향.방법 회고성분석중국의과대학부속제일의원2002년1월지2012년6월수치적387례AAA환자적림상자료,경사선후납입연구범위AAA환자255례.환자분위3조(배제30 d내사망20례),기중강내수복(EVAR)조62례,개복수술조76례,미수술조97례.정상혈홍단백수평안110 ～ 160 g/L계,안아국진단표준,재해평면지구,남성＜120 g/L,녀성(비임신)＜110 g/L인위빈혈.환자평균수방시간(63 ±42)개월.응용다중선성회귀방법연구환자혈홍단백수평여류체직경대소적관계,Kaplan-Meier생존곡선비교이상3조중빈혈여비빈혈환자생존솔,COX비례풍험회귀모형분석환자예후.결과 공유88(34.5％)례술전혹미수술환자합병빈혈.재다중선성회귀모형중납입각충영향인소후,혈홍단백수평여복주동맥류류체최대직경정부상관(β=-0.152,P=0.017).경수방후,상술3조중빈혈조환자5년생존솔분별위56％、51％、42％,비빈혈환자5년생존솔분별위94％、90％、80％.빈혈조환자생존솔저우비빈혈조환자(P=0.005,0.001,0.025).COX비례풍험회귀모형납입각충영향인소후,혈홍단백수평여환자사망상관,상대위험도분별위0.923、0.963、0.963;P치분별위0.001、0.002、0.028;95％CI분별위0.8798 ～ 0.970,0.941 ～0.986,0.932～0.996).결론 AAA환자혈홍단백수평위영향복주동맥류직경적독립인소,빈혈강저복주동맥류환자적원기생존솔.
Objective To assessed the relationships between hemoglobin concentration from the patients with abdominal aortic aneurysm (AAA) and its diameter as well as patients' long-term survival.Methods Between January 2002 to June 2012, 255 AAA patients were reviewed retrospectively.The outcomes were compared between 3 groups of different treatments ( excluding 20 cases dead within 30 days).The procedures included open AAA repair ( n =76),endovascular (EVAR) ( n =62) and non-operated (n =97).The mean follow-up period was 63 ±42 months.The association of hemoglobin level with AAA diameter was assessed with multiple linear regression.Kaplan-Meier survival curves of anemic and non-anemic patient groups were compared by the log-rank method in 3 groups.Cox's proportional hazard regression mode was used to determine the effects of anemia on vital status after EVAR,open AAA repair or non-operation.Results A total of 88 (34.5％ ) of AAA patients had anemia.After adjustment for various risk factors,hemoglobin level was inversely correlated with maximal AAA diameter (β =-0.152,P =0.017).During a long-term follow-up,the 5-year survival rates were 56％,51％ and 42％ in anemic patients versus 94％,90％ and 80％ in non-anemic ones.Survival was lower in anemic patients than those without anemia in 3 groups ( P =0.005,0.001,0.025 by log-rank respectively).In three groups,according to multivariable Cox regression analysis,the hemoglobin levels were independently correlated with long-term mortality respectively after adjusting for various risk factors.The hemoglobin levels were correlated with death ( HR:0.923,0.963,0.963 ; P:0.001,0.002,0.028 ; 95％ CI:0.8798-0.970,0.941-0.986,0.932-0.996 ).Conclusion Hemoglobin concentration is independently associated with AAA diameter and reduced long-term survival after undergoing EVAR,open AAA repair and non-operation.
