胸降主动脉夹层合并冠心病患者的临床特点分析

Clinical characteristics of patients with descending aortic dissection disease and coronary heart disease

目的分析胸降主动脉夹层合并冠心病患者的发病率、发病危险因素及临床特点,为今后的诊断、治疗提供参考.方法：回顾性分析行主动脉腔内修复术及冠状动脉造影术患者356例的临床资料.根据冠状动脉造影结果分为冠心病组与非冠心病组,比较两组患者的基线资料、临床特点.结果：冠心病组患者142例,占39.89%,单支血管病变97例,占68.3%,两支血管病变34例,占23.9%,三支血管病变7例,占4.9%,LM＋三支病变4例,占2.8%.非冠心病组患者214例,占60.11%.冠心病组比非冠心病组年龄大、并发糖尿病患者比例高.非冠心病组比冠心病组有更高的急性发病率,差异有统计学意义（P〈0.05）.采用多因素Logistic回归分析显示,年龄、高脂血症是胸降主动脉夹层合并冠心病的独立危险因素.结论：胸降主动脉夹层合并冠心病患者的发病比例高,年龄、高脂血症是胸降主动脉夹层合并冠心病的独立危险因素.有危险因素的患者行降主动脉扩张性疾病介入诊治术的同时行冠状动脉造影术以明确冠心病诊断,必要时联合经皮冠状动脉介入治疗,可改善患者预后.

ObjectiveTo evaluate the incidence,risk factors and clinical characteristics of coronary heart disease in patients with descending aortic dissection disease and provide some references for future diagnosis and treatment.Methods：From April 2002 to Augst 2015,a total of 356 in hospital patients with descending aortic dissection disease and coronary heart disease receiving interventional therapy and coronary angiography in the General Hospital of Shenyang Military were enrolled in this study. The patients were divided into coronary heart disease group（CHD group）and non coronary heart disease group（non-CHD group）by the angiographic results.Baseline data and clinical characteristics between the two groups were compared.Results： Totally 142（39.89%）patients were diagnosed as CHD by coronary angiography,of which,97（68.3%）patients were with one vessel lesion,34（23.9%）patients were with two vessel lesions and 7（4.9%）patients were with three vessel lesions（including 4 patients suffering from left main coronary artery disease）.Totally 214（60.11%）patients were diagnosed as non CHD by coronary angiography.Compared with patients in non CHD group, patients in CHD group were much older,and had significantly higher proportions of diabetes mellitus.However,patients in non CHD group had higher proportions of acute incidence of descending aortic dissection.Multivariate Logistic regression analysis showed that age and hyperlipemia were a1l independent predictors of coronary heart disease in patients with descending aortic dissection disease and coronary heart disease.Conclusions：Incidence of coronary heart disease in patients with descending aortic dissection is high in this study.Age and hyperlipemia were a1l independent predictors of coronary heart disease in patients with descending aortic dissection disease and coronary heart disease.It is safe and feasible for patients with the risk factors to receive coronary angiography for the diagnosis of CHD when performed endovascular graft exclusion.If necessary,combined pereutaneous coronary intervention can be a suitable choice to improve the prognosis of these patients.