汉族与高加索族急性主动脉夹层的发病特点和临床疗效比较

Comparative study in clinical features and managements of aortic dissection between Chinese and Caucasians

目的 评价汉族和高加索族急性主动脉夹层（AD）的发病特点,比较2组人群治疗方式选择、疗效及预后等方面的差异.方法 按系统评价的要求,全面检索MEDLINE（1980至2014年）、Emabse（1980至2014年）、中国生物医学文献数据库（CBM,1980至2014年）和中国期刊全文数据库（CNKI,1980至2014年）,应用STATA 12.0对纳入的文献进行数据提取及荟萃分析.结果 高加索族患者共纳入6 697例Stanford A型和3 381例B型AD.汉族患者共纳入850例A型和4 745例B型AD.汉族患者平均年龄偏低,男性比例为84.5％,高于高加索族患者的66.9％,差异有统计学意义（x2 =365.37,P＜0.01）,既往烟酒史、冠心病病史患者比例分别为53.0％、13.8％,高于高加索族的16.5％、7.7％,差异有统计学意义（x2=264.23、68.417,P＜0.01）.B型夹层中,汉族患者既往高血压病史、糖尿病病史比例分别为85.7％、13.3％,高于高加索族的75.6％、7.8％,差异有统计学意义（x2=111.27、30.613,P＜0.01）.汉族患者术前多出现神经系统和心脏损伤,高加索族却多出现肾和外周血管损伤.在治疗方式的选择上,高加索族采用开放手术患者明显高于汉族.汉族AD患者更多采用腔内修复术.B型夹层腔内修复术术后30 d死亡率,汉族为2.4％,低于高加索族的11.2％,差异有统计学意义（x2=142.96,P＜0.01）.结论 中国汉族人群现阶段AD患者发病率逐年增加,相对于高加索族人群发病年龄较低,但基础疾病较多.尽管国内采用外科干预的早期死亡率及并发症发生率较低,但由于可用数据局限,需要进一步增加样本及中远期随访.

Objective To explore differences in the clinical characteristics,treatment methods and progness of Chinese （Han） and Western populations （Caucasia） aortic dissection （aortic dissection,AD） patients.Methods According to the requirements of systematic review,We searched MEDLINE （1980-2014）,Emabse （1980-2014）,CBM （1980-2014） and CNKI （1980-2014） database overall,the meta-analyses were performed through STATA 12.0.Results A total of 6 697 Stanford A AD and 3 381 Stanford BAD Caucasian patients and 850 Standford A AD and 4 745 Stanford B AD Chinese Han patients were deemed eligible.It showed that average age of Han patients was lower,the proportion of Han group was 84.5％,while Cuacasian group was 66.9％,the differences were statistically significant（x2 =365.37,P ＜ 0.01）.Han patients with history of smoking and that of coronarty heart diseases accounted for 53.0％,13.8％ separately,which were higher than those of Caucasian group,the differences were also statistically significant （x2 =264.23,68.417,P ＜0.01）.Besides these,the proportions of Han Stanford B AD patients who had hypertension,diabetes were also statistically significant higher than Caucasian group（x2 =264.23,68.417,P ＜0.01）.The Chinese group was more likely to appear nervous system and heart damages before surgery while the Caucasian group mostly appeared kidney and peripheral vascular damages.In the choice of treatment,the number of open surgery patients was significantly higher than that in Caucasian group.Domestic acute AD patients were more likely to accept TEVAR.The 30-day mortality of Chinese Han group in Stanford B was 2.4％,while Caucasians＇ mortality was 11.2％,the differences were statistically significant（x2 =142.96,P ＜ 0.01）.Conclusions The incidence of Chinese AD patients who are younger with more basic diseases has been increasing gradually,Although the 30-day mortality and complications rates of Chinese patients accepting early surgery intervention are lower than Caucasians,due to the less available data,large sample researches and further long-term follow-up will be needed.