穿透性主动脉溃疡患者术后免疫抑制剂辅助治疗的临床研究

目的分析穿透性主动脉溃疡（PAU）患者行胸主动脉腔内修复术（TEVAR）后免疫抑制剂辅助治疗的疗效。方法回顾性分析2002年7月＆2012年5月98例穿透性主动脉溃疡症患者的临床资料。根据术后7—12d是否使用雷公藤多苷和强的松进行辅助治疗将患者分为观察组和对照组。平均随访（32．4±6．3）个月，记录复发率。采用酶联免疫吸附法检测血清中血管细胞粘附分子（VCAM-1）和热休克蛋白60（HSP60）的表达水平。结果与对照组比较，术后1个月观察组血清中VCAM-1和HsP60水平下降。随访结束，观察组复发率11．11％．对照组复发率31．91％。结论PAU患者TEVAR术后行免疫抑制剂辅助治疗能够显著降低复发率。

Objective To review our experience in the diagnosis and treatment for 98 cases with penetrating aortic deer （ PAU ） after thoracic aortic lumen repair （ TEVAR ） postoperative use of immunosuppressant adjuvant therapy. Methods A retrospective analysis was performed on 98 cases of PAU with histopathological from July 2002 to May 2012. After TEVAR, patients were treated with （ treatment group ） or without （ control group ） tripterygium glycosides and prednisone for about 7 to 12 days. The average of follow-up is 32.4 ＋ 6.3 months and the recurrence rate was recorded. Serum levels of vascular cellular adhesion molecule-1 （ VCAM-1 ） and heat shock protein 60 （ HSP60 ） were determined by ELISA. Results The serum levels of VCAM-1 and HSP60 were significantly reduced one month after TEVAR in treatment group, but were only modestly reduced in control group. After about three years follow- up, the recurrence rate of patients in the treatment group （ 11.11% ） was significantly lower than that in the control group 31.91% ） . Conclusion Adjuvant therapy with immunosuppressants can effectively attenuate the recurrence rate of PAU after TEVAR.