他汀类药物对Stanford B型主动脉夹层患者主动脉腔内修复术疗效的影响

Effect of atatins on long-term outcomes in patients with stanford b aortic dissection treated with endovascular aortic repair

目的观察他汀类药物对Stanford B型主动脉夹层患者行主动脉腔内修复术疗效的影响。方法回顾性分析2002年4月至2013年10月于沈阳军区总医院心血管内科住院治疗并行主动脉腔内修复术治疗的Stanford B型主动脉夹层患者388例,分析他汀组与非他汀组临床特点及主动脉腔内修复术后围手术期及3年随访的死亡率、再次行主动脉腔内修复术等事件的发生率。结果 (1)两组患者临床资料比较:两组患者的性别、年龄及体重指数等无统计学意义(P均>0.05);他汀组与非他汀组患糖尿病、脑卒中的比例无统计学意义(P均>0.05);他汀组高血压病、冠心病的比例明显高于非他汀组(P均<0.05);他汀组服用阿司匹林肠溶片的比例明显高于非他汀组(P<0.001);两组患者伴胸腔积液、心包积液的比例无统计学差异(P均>0.05)。(2)围手术期情况:两组患者植入支架的数目、长度、近远端直径及内漏的发生等差异均无统计学意义(P均>0.05);非他汀组完全封闭左锁骨下动脉的比例明显高于他汀组(P=0.020);两组患者围术期死亡、术后发热、脑卒中、肢体活动障碍及住院时间等差异均无统计学差异(P均>0.05);他汀组合并PCI的比例明显高于非他汀组(P<0.001)。(3)随访时间36个月,随访率为79.5%。随访期间两组患者死亡率、再次行主动脉腔内修复术、新发冠心病、脑卒中、截瘫等均无统计学差异(P均>0.05)。结论单中心研究未显示他汀类药物可以改善主动脉夹层患者行主动脉腔内修复术的近远期生存率。

Objective To determine whether statin intake is associated with improved in-hospital and long-term outcomes for Stanford type B aortic dissection treated with endovascular aortic repair. Methods From April 2002 to October 2013,a total of 388 patients with Stanford B aortic dissection treated with endovascular repair in General hospital of Shenyang Military Region, of whom 118 were taking statins and 270 were not,to access clinical features,in-hospital and late outcomes during follow-up for 3 years. Results In clinical characteristics, age,the incidence of diabetic and stroke were similar in two groups.Statin group with hypertension,coronary heart disease and intaking Aspirin were higher.There were no significant difference between two groups in other clirLical characteristics. There were no significant difference in stentgrafts characteristics and in-hospital complication.During follow-up, compared with statin group, the complication of all-cause mortality, reintervention, coronary disease, cerebrovascular diseases in non statin group had no significant difference in in-hospital and late term outcomes.On Kaplan-Meier analysis, the survival rate of patients between two groups had no significant difference（P=0.472）. Conclusions In general,we conclude that statin therapy at the beginning of the trial is not independently associated with improved in-hospital and long-term survival for Stanford type B aortic dissection treated with endovascular aortic repair.