B型主动脉夹层患者与健康人群主动脉弓部弯曲差异的比较

Difference in aortic arch tortuosity between patients with type B aortic dissection and healthy people

目的测量并比较B型主动脉夹层患者与健康人群的主动脉弓部弯曲指标。方法本研究属于观察性横断面研究。纳入来源于中国B型主动脉夹层多中心临床注册研究(ROBOUST)中B型主动脉夹层患者140例,其中男性114例,女性26例;平均年龄(55.05±11.38)岁;另选取2016年12月-2017年1月于解放军总医院查体并行胸部CTA检查的健康人群(n=124),其中男性106例,女性18例;平均年龄(56.91±10.59)岁。两组性别、年龄、体质量指数、高血压等基本资料差异无统计学意义(P>0.05)。基于CTA血管中心线弯曲参数测量的方法,分别测量主动脉夹层患者与健康人群近端主动脉的整体和局部弯曲指标。整体弯曲指标应用弯曲指数(tortuosity index);局部弯曲指标,则根据Ishimaru主动脉弓部分区,通过最大弯曲角度(maximal tortuosity angle)指标分别测量Zone 0~2区。结果B型主动脉夹层患者在近端主动脉整体弯曲指数显著高于健康人群(1.27±0.07 vs 1.23±0.04,P<0.001)。局部弯曲情况则有所不同。夹层患者与健康人群相比,在Zone 1及Zone 2弯曲度更大[Zone 1:(24.21±8.45)°vs(18.13±5.71)°,P<0.001];Zone 2:[(30.76±8.62)°vs(27.07±7.58)°,P<0.001],而在Z0区相对平坦[(28.48±5.03)°vs(29.63±4.34)°,P=0.049],组间差异有统计学意义。结论对比健康人群,夹层患者弓部整体弯曲程度增加,主要是由于Zone 1及Zone 2局部弯曲增加所致,而与Zone 0变化无关。

Objective To compare the tortuosity of aortic arch between patients with type B aortic dissection(TBAD)and healthy control.Methods An observational cross-sectional study was performed in 140(114 males and 26 females with average age of 55.05±11.38 years)TBAD patients selected from ROBOUST and 124 healthy people(106 males and 18 females with average age of 56.97±10.59 years)who underwent CTA examination in the first medical center of Chinese PLA General Hospital from December 2016 to January 2017.There was no significant difference in baseline data,such as gender,age,BMI and hypertension,between the two groups.Based on center lumen line analysis on 3D CTA,the global and local tortuosity of proximal aorta in the TBAD and healthy control were evaluated respectively.The global tortuosity of proximal aorta was measured by Tortuosity index(TI).According to Ishimaru aortic arch definition,the description of maximal tortuosity angle was used to assess the local tortuosity across Zone 0 to Zone 2,respectively.Results The tortuosity index of proximal aorta in patients with type B aortic dissection was significantly higher than that of the healthy control group(1.27±0.07 vs 1.23±0.04,P<0.001).Compared to healthy people,more curved Zone 1 and Zone 2 were found in TBAD patients(Zone 1:[24.21±8.45]°vs[18.13±5.71]°,P<0.001;Zone 2:[30.76±8.62]°vs[27.07±7.58]°,P<0.001).In contrast,less tortuous Zone 0 was observed in TBAD patients([28.48±5.03]°vs[29.63±4.34]°,P<0.001).Conclusion Compared with healthy people,the tortuosity index of proximal aorta is higher in patients with type B aortic dissection,which is due to more curved Zone 1 and Zone 2 and it has nothing to do with the changes of Zone 0.