雌激素和年龄对女性A型主动脉夹层的影响研究

Effects of estrogen and age on type A aortic dissection in women

目的探讨雌激素和年龄对女性A型主动脉夹层患者的影响。方法选择2022年1月至2023年12月就诊于西安交通大学第一附属医院的A型主动脉夹层女性188例为研究对象,按照年龄及绝经情况,将患者分为45岁及以下未绝经低龄组、46~55岁未绝经中龄组、46~55岁绝经中龄组、56岁及以上绝经高龄组,分别比较患者一般情况、术前炎性指标、血脂指标、肝肾功能、动脉粥样硬化及假腔血栓发生率,以及术中死亡率、术后死亡率、术后30天死亡率等情况。结果在女性A型主动脉夹层患者中,低龄未绝经组、中龄未绝经组、中龄绝经组、高龄绝经组的年龄(F=210.609),以及高血压史(χ^(2)=14.860)、糖尿病史(χ^(2)=16.451)的分布比较,差异均有统计学意义(P<0.05)。进一步两两组间比较显示,中龄未绝经组与低龄未绝经组、中龄绝经组与高龄绝经组的年龄比较,差异均有统计学意义(t值分别为-10.160、-16.727,P<0.05);中龄未绝经组与低龄未绝经组的高血压史和糖尿病史的分布比较,差异均有统计学意义(χ^(2)值分别为6.232、5.590,P<0.05)。四组的总胆固醇、甘油三酯、白细胞、中性粒细胞、中性粒细胞/淋巴细胞、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、肌酐、尿素氮(F值分别为507.933、28.406、491.647、333.681、219.088、70.116、117.717、169.324、72.662),以及动脉粥样硬化、假腔血栓的分布(Fisher确切概率法,P值分别为<0.001、0.006)比较,差异均有统计学意义(P<0.05)。进一步两两组间比较显示,中龄未绝经组与低龄未绝经组的白细胞、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、肌酐、尿素氮比较,差异均有统计学意义(t=-6.412~-2.299,P<0.05);中龄未绝经组与中龄绝经组的总胆固醇、甘油三酯、白细胞、中性粒细胞、中性粒细胞/淋巴细胞、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、肌酐、尿素氮比较,差异均有统计学意义(t=3.544~17.020,P<0.05);中龄绝经组与高龄绝经组的总胆固醇、甘油三酯、白细胞、中性粒细胞、中性粒细胞/淋巴细胞、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、肌酐比较,差异均有统计学意义(t=-13.363~-3.026,P<0.05)。四组的呼吸机辅助时间比较,差异有统计学意义(F=0.979,P<0.05)。结论女性A型主动脉夹层患者的高血压史和糖尿病史主要与年龄有关,而患者血脂、炎性细胞、肝肾功能水平、动脉粥样硬化等因素均为年龄和雌激素综合作用所致。

Objective To investigate the effects of estrogen and age on female patients with type A aortic dissection.Methods A total of 188 female patients with type A aortic dissection treated at the First Affiliated Hospital of Xi′an Jiao Tong University from January 2022 to December 2023 were selected as the study subjects.According to age and menopausal status,the patients were divided into four groups:a low-age group(45 years and younger,premenopausal),a middle-age group(46-55 years,premenopausal),a middle-age menopausal group(46-55 years,postmenopausal),and an elderly menopausal group(56 years and older,postmenopausal).The general conditions,preoperative inflammatory indexes,blood lipid indexes,liver and kidney function,incidence of atherosclerosis and false lumen thrombosis,as well as intraoperative mortality,postoperative mortality,and 30-day postoperative mortality were compared among the groups.Results In female patients with type A aortic dissection,the comparisons of age(F=210.609)among the low-age premenopausal group,middle-age premenopausal group,middle-age menopausal group,and elderly menopausal group,as well as the distribution of history of hypertension(χ^(2)=14.860)and history of diabetes(χ^(2)=16.451),showed statistically significant differences(P<0.05).Further pairwise comparisons revealed statistically significant differences in age between the middle-age premenopausal group and the low-age premenopausal group,as well as between the middle-age menopausal group and the elderly menopausal group(t-values were-10.160 and-16.727,respectively,P<0.05).Additionally,the comparisons of the distribution of hypertension history and diabetes history between the middle-age premenopausal group and the low-age premenopausal group also showed statistically significant differences(χ^(2)values were 6.232 and 5.590,respectively,P<0.05).The comparisons of total cholesterol,triglycerides,white blood cell count,neutrophil count,neutrophil-to-lymphocyte ratio,alanine aminotransferase,aspartate aminotransferase,creatinine,and blood urea nitrogen among the four groups(F values were 507.933,28.406,491.647,333.681,219.088,70.116,117.717,169.324 and 72.662,respectively),as well as the distribution of atherosclerosis and false lumen thrombosis(Fisher's exact tests,P values were<0.001 and 0.006,respectively),showed statistically significant differences(P<0.05).Further pairwise comparisons showed that the differences in white blood cell count,alanine aminotransferase,aspartate aminotransferase,creatinine,and blood urea nitrogen between the middle-age premenopausal group and the low-age premenopausal group were statistically significant(t=-6.412 to-2.299,P<0.05).The differences in total cholesterol,triglycerides,white blood cell count,neutrophil count,neutrophil-to-lymphocyte ratio,alanine aminotransferase,aspartate aminotransferase,creatinine,and blood urea nitrogen between the middle-age premenopausal group and the middle-age menopausal group were also statistically significant(t=3.544 to 17.020,P<0.05).The differences in total cholesterol,triglycerides,white blood cell count,neutrophil count,neutrophil-to-lymphocyte ratio,alanine aminotransferase,aspartate aminotransferase,and creatinine between the middle-age menopausal group and the elderly menopausal group were statistically significant(t=-13.363 to-3.026,P<0.05).The comparison of ventilator-assisted time among the four groups showed statistically significant differences(F=0.979,P<0.05).Conclusion The history of hypertension and diabetes in female patients with type A aortic dissection is primarily related to age,while factors such as serum lipid levels,inflammatory cells,liver and kidney function,and atherosclerosis in patients are the result of the combined effects of age and estrogen.