急性降主动脉夹层合并冠心病患者临床特点与危险因素分析

Clinical characteristics and risks factors of descending aortic dissection coronary heart disease

目的探讨急性降主动脉夹层合并冠心病患者的临床特点与危险因素,为其临床早期诊治提供依据。方法收集沈阳军区总医院心血管内科自2002年4月至2016年11月收治的448例急性降主动脉夹层患者,根据冠状动脉造影结果分为冠心病组与非冠心病组,分析两组患者的临床特点与危险因素。结果冠心病组患者173例,非冠心病组患者275例。冠心病组患者年龄、血小板计数、B型利钠肽、肌酸激酶、肌钙蛋白阳性率均高于非冠心病组,差异均有统计学意义(P<0.05);冠心病组患者第一破口距左锁骨下动脉开口外缘的距离更远,于非冠心病组比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析提示,年龄与第一破口距左锁骨下动脉开口外缘的距离是急性降主动脉夹层合并冠心病的独立危险因素。结论急性降主动脉夹层合并冠心病的发病率较高,年龄与第一破口距左锁骨下动脉开口外缘的距离是其独立危险因素。

Objective To investigate the clinical characteristics and risk factors descending aortic dissection and coronary heart dis- ease, and provide some references for early diagnosis and treatment. Methods A retrospective study was performed on 448 patients with descending aortic dissection who were admitted from April 2002 to November 2016. Patients were divided into the coronary heart disease（CHD） group and non coronary heart disease （non-CHD） group by angiographic results. Clinical coronary characteristics and risk factors between the two groups were compared. Results There were 173 patients in coronary heart disease group and 275 patients in non-coronary heart disease group. Age, platelet count, B-type natriuretic peptide, creatine kinase and troponin positive rate in pa- tients of CHD group were higher than those in non-CHD group, and the difference was statistically significant（ P 〈 0.05 ）. The distance from first aortic rupture to the exterior margin of left subclavian artery was longer（ P 〈 0. 05 ）. Multivariate Logistic regression analysis showed that, the distance from first aortic rupture to the exterior margin of ]eft subclavian artery longer was independent risk factor that indicated the descending aortic dissection and coronary heart disease. Conclusion The incidence of descending aortic dissection com- bined with coronary heart disease in patients is high, age and the distance from first aortic rupture to the exterior margin of left subcla- vian artery were main predictors of patients with descending aortic dissection and coronary heart disease.