合并高血压的自发性主动脉夹层患者神经系统症状的临床分析

Clinical analysis of neurological symptoms in patients with spontaneous aortic dissection complica-ted with hypertension

目的探讨合并高血压的自发性主动脉夹层(AD)患者神经系统症状的特点及影响因素。方法对935例临床诊断为自发性AD患者的临床资料进行回顾性分析(包括临床症状、体征以及影像学资料)。按伴有高血压(617例)与不伴有高血压(318例)分为两组。依据Stanford分型标准,将AD分为A型(夹层累及升主动脉)和B型(夹层仅累及左侧锁骨下动脉开口远段的主动脉)。结果①高血压组有167例(27.1%)患者表现出神经系统症状,常见症状包括头晕43例(7.0%),晕厥38例(6.2%),一侧下肢感觉障碍35例(5.7%),昏迷16例(2.6%),下肢单瘫16例(2.6%),截瘫13例(2.1%),偏瘫8例(1.3%),头痛8例(1.3%)。两组患者间各种神经系统症状差异无统计学意义。②A型AD患者的神经系统症状伴有高血压者晕厥的发生率高于不伴有高血压的患者,差异有统计学意义(10.7%比5.2%,P<0.05)。有神经系统症状的AD患者中,A型AD比率显著高于无神经系统症状患者A型的比率(75.7%比49.1%),差异有统计学意义,P<0.001。③多因素Logistic回归分析显示,A型AD是发生神经系统症状的独立危险因素(OR=3.385,95%CI:2.415～4.473,P<0.001)。高血压不是发生神经系统症状的独立危险因素(OR=1.365,95%CI:0.961～1.938,P=0.082)结论高血压合并AD患者神经系统症状常见,夹层累及升主动脉为导致神经系统症状的独立危险因素;高血压并非造成神经系统症状的独立危险因素。

Objective To investigate the characteristics of neurological symptoms in patients with spontaneous aortic dissection complicated with hypertension. Methods The clinical data, including the clinical symptoms, signs and imaging data, of 935 patients diagnosed as spontaneous aortic dissection （AD） were analyzed retrospectively. The patients were divided into a complicated hypertensive group （n = 617） and a normotensive group （n = 318）. The AD was divided into type A and type B according to Stanford classification. Results （~）A total of 167 AD patients （27.1% ） complicated with hypertension showed neurological symptoms including dizziness （ n = 43, 7.0% ）, syncope （ n = 38, 6.2% ）, unilateral lower extremity sensory disturbance （n =35, 5.7% ） , coma （n = 16, 2.6% ） , lower limb monoplegia （n = 16, 2.6%）, paraplegia （n = 13, 2. 1%）, hemiplegia （n =8, 1.3%）, and headache （n=8, 1.3%）. There were no significant differences in the neurological symptoms between the hypertensive group and the normotensive group. （2）The incidence of syncope in type A patients with hypertension was higher than those without hypertension. There was significant difference （10.7% vs. 5.2% ;P 〈0.05）. In the AD patients with neurological symptoms, the proportion of type A was significantly higher than that in the AD patients without neurological symptoms. There was significant difference （75.7% vs. 49.1% ;P 〈 0.001 ）. （3）Mul- tivariate logistic regression analysis showed that type A was an independent risk factor for the occurrence of neurological symptoms （ OR =3. 385, 95% CI 2. 415 to 4. 473 ;P 〈0. 001 ）. Hypertension was not an inde- pendent risk factor for the occurrence of neurological symptoms （ OR = 1. 365, 95% C10. 961 to 1. 938 ;P = 0. 082）. Conclusion The neurological symptoms of AD patients with hypertension is common. Dissection involving the ascending aorta is an independent risk factor for causing neurological symptoms, hypertension is not the independent risk factor for causing neurological symptoms.