广州市主动脉夹层临床特征变化趋势十年回顾性分析

Change trend of clinical characteristics of aortic dissection over 10 years

目的探讨广州市10年来主动脉夹层的临床特征变化趋势。方法回顾分析广东省心血管病研究所1996年1月—2005年12月10年间连续收治并经影像学检查确诊为主动脉夹层的患者,对每年患者的总数、年龄、性别、夹层类型、治疗方法和疾病预后进行统计和组间的比较分析。结果10年共确诊主动脉夹层339例,发病平均年龄(55.7±11.2)岁,男女之比为4.75:1。243例(71.7%)患者出院诊断合并高血压病,177例(52.2%)患者有明确的大量吸烟史。Ⅰ型、Ⅱ型、Ⅲ型夹层构成比分别为32.3%、5.1%、62.6%。广州市急性A型主动脉夹层住院病死率35.3%,急性 B型主动脉夹层住院病死率8.0%。在两个五年周期中,主动脉夹层病例增加了165%。Ⅰ型夹层增长最快,为270%。平均发病年龄无显著变化。广州市急性主动脉夹层病例1年预后呈现改善趋势,但未达统计学意义。结论主动脉夹层的住院患者在迅速增多,平均发病年龄明显低于国外报道;男性比例高于国外报道。急性主动脉夹层 A 型住院病死率高于国外报道的数据。在疾病流行的大背景下,急性主动脉夹层1年预后呈现改善趋势。在主动脉夹层的预防与治疗方面亟待更多的关注与探索。

Objective To discuss the clinical epidemiology features and change trend of aortic dissection （AD）. Methods Retrospective analysis of consecutive 339 patients with AD over 10 years in Guangdong Cardiovascular Institution. Hospital records and prognosis were compared between two five-year periods. Results 339 cases with AD were hospitalized during the past 10 years. The mean age was 55.7 ± 11.2. The male/female ratio was 4.75 to 1. Hypertension was present in 71.7% of all patients. Heavy smoking history was dicited in 52. 2% of all the patients. Type Ⅰ dissection were identified in 32. 3% of all the cases,type Ⅱ in 5. 1% ,and type Ⅲ in 62.6%. In-hospital mortality of acute type A dissection was 35.3%, acute type B dissection 8. 0%. In two five-year periods, the total number of cases increased by 165%, among which type Ⅰ was the fastest, increased by 270%. Changes of mean age and male/ female ratio were not significant. For acute AD, changes of prognosis in one year improved, but did not reach statistical significance. Conclusions This study provides insight into current regional profiles of AD. The number of hospitalized patients with AD is increasing dramatically. The mean age of the first-attack is much younger and the male ration is much higher than that reported by other regional researchers. Limited by sample size, one year prognosis of acute AD dissection improved, but did not reach statistical significance. These data support the urgent need for further improvement in prevention and treatment of AD.