476例主动脉夹层发病时间分布特点研究

Features of time distribution in the onset of aortic dissection of 476 patients

目的探讨主动脉夹层（AD）患者发病时间分布特点。方法采用回顾性横断面研究方法。收集2009年1月至2017年6月安徽医科大学第一附属医院收治的476例AD患者的临床资料。将纳入患者按以下标准划分：性别、年龄[青年（〈45岁）、中年（45～59岁）和老年（≥60岁）]、Stanford分型（A型和B型）、是否合并高血压病。将各变量纳入圆形统计法分析患者发病的时间（月份和昼夜）分布情况。观察指标：（1）患者整体发病时间分布情况。（2）不同性别患者发病时间分布情况。（3）不同年龄患者发病时间分布情况。（4）不同Stanford分型患者发病时间分布情况。（5）是否合并高血压病患者发病时间分布情况。正态分布的计量资料以x±s表示，计数资料用构成比表示。采用圆形统计法计算三角函数变换后的发病时间资料。采用Rayleigh检验（统计量为Z值）分析发病月份节律性和昼夜节律性。结果（1）患者整体发病时间分布情况：AD患者发病具有明显月份节律性和昼夜节律性（Z=14．79，31．60，P〈0．05）。发病最多月份为11月（59例），最少月份为8月（24例），发病高峰日为1月12日；发病最多时段为16：00—17：00（37例），发病最少时段为3：00—4：00（8例），发病高峰时刻为14：55。（2）不同性别发病时间分布情况：男性患者具有发病月份节律性和昼夜节律性（Z=11．28，27．81，P〈0．05）；女性患者也具有发病月份节律性和昼夜节律性（z=3．48，4．37，P〈0．05）。（3）不同年龄患者发病时间分布情况：青年患者不具有发病月份节律性（z=1．33，P〉0．05），而具有发病昼夜节律性（Z=4．29，P〈0．05）；中年患者具有发病月份节律性和昼夜节律性（Z=7．48，17．41，P〈0．05）；老年患者也具有发病月份节律性和昼夜节律性（Z=6．62，11．04．P〈0．05）。（4）不同Stanford分型患者发病时间分布情况：StanfordA型患者不具有发病月份节律性（z=1．60，P〉0．05）。而具有发病昼夜节律性（Z=10．51，P〈0．05）；StanfordB型患者具有发病月份节律性和昼夜节律性（z=13．94，21．70，P〈0．05）。（5）是否合并高血压病患者发病时间分布：高血压患者具有发病月份节律性和昼夜节律性（z=12．08，29．81，P〈0．05）。血压正常患者不具有发病月份节律性（Z=3．84，P〉0．05），而具有发病昼夜节律性（z=4．78，P〈0．05）。结论AD好发于天气寒冷的月份及午后时段。

Objective To investigate the features of time distribution in the onset of aortic dissection （AD）. Methods The retrospective cross-sectional study was conducted. The clinical data of 476 AD patients who were admitted to the First Affiliated Hospital of Anhui Medical University from January 2009 to June 2017 were collected. The patients were divided by the following criteria： gender, age [ youth（ 〈45 years）, middle-age （45- 59 years） and elderly （≥ 60 years） ], Stanford types （ type A and type B ）, with or without hypertension. All variables were analyzed by circular distribution statistics to illuminate the features of time distribution in the onset of AD （monthly rhythm and circadian rhythm）. Observation indicators： （ 1 ） overall time distribution of AD; （2） time distribution of subgroups with different genders ; （3） time distribution of subgroups with different age ; （4） time distribution of subgroups with different Stanford types; （5） time distribution of subgroups with or without hypertension. Measurement data with normal distribution were represented as x±s and count data were described as constituent ratio. The circular distrbution statistics were used to calculate time data of onset after trigonometric function transformation. The monthly rhythm and circadian rhythm were done using the Rayleigh test （Z value）. Results （ 1 ） Overall time distribution of AD ： the AD patients had the monthly rhythm and circadian rhythm （Z= 14. 79, 31.60, P〈0. 05）. The months with the maximum and minimum cases were November （59 cases） and August （24 cases） respectively, the peak day was on January 12. AD often occurred from 16：00 to 17：00 （37 cases） but barely occurred from 3：00 to 4：00 （8 cases） , with a peak of 14：55. （2） Time distribution of subgroups with different gender： male subgroup had the monthly rhythm and circadian rhythm （Z = 11.28, 27. 81, P〈0. 05） ; female subgroup had the monthly rhythm and circadian rhythm （Z=3.48, 4. 37, P〈0.05）. （3） Time distribution of subgroups with different age： patients in the youth subgroup had no monthly rhythm （Z= 1.33, P〉 0.05）, and there was the circadian rhythm （Z = 4. 29, P〈0.05 ） ; patients in the middle-age subgroup had the monthly rhythm and circadian rhythm （Z = 7.48, 17.41, P〈0.05） ; patients in the old-age subgroup had the monthly rhythm and circadian rhythm （ Z = 6. 62, 11, 04, P 〈 0. 05 ）. （4） Time distribution of subgroups with different Stanford type： patients in the type A subgroup had no monthly rhythm （Z= 1.60, P〉0. 05）, and there was the circadian rhythm （Z = 10. 51, P〈 0.05 ） ; patients in the type B subgroup had the monthly rhythm and circadian rhythm （ Z = 13.94, 21.70, P〈0.05 ）. （5） Time distribution of subgroups with or without hypertension ： subgroups with hypertension had the monthly rhythm and circadian rhythm （Z = 12.08, 29. 81, P〈0.05）. Subgroups without hypertension had no monthly rhythm （Z= 3.84, P〉0.05）, showing a statistically significant difference in the circadian rhythm （Z= 4. 78, P〈0. 05）. Conclusion AD often occurs in cold months and afternoon.