覆膜支架腔内修复术与药物保守治疗对Stanford B型主动脉夹层动脉瘤患者肝肾功能、炎性因子以及预后的影响

Effect of Endovascular Repair of Covered Stent and Drug Conservative Treatment on Liver and Renal Function, Inflammatory Factors and Prognosis in Patients with Stanford B Aortic Dissecting Aneurysm

目的:比较覆膜支架腔内修复术与药物保守治疗对Standford B型主动脉夹层动脉瘤的疗效及对患者肝肾功能、炎性因子及预后的影响。方法:选择2012年1月~2014年8月我院收治的Standford B型主动脉夹层动脉瘤患者68例,按照随机数字表法分为对照组与研究组,各34例。对照组入院后采取药物保守治疗,研究组应用覆膜支架腔内修复术治疗。观察两组住院期间死亡率、再次手术或介入率以及治疗前、治疗2周后肝肾功能、血清炎性因子变化。所有患者随访36个月,比较两组患者预后情况。结果:研究组再次手术或介入率为2.94%,低于对照组的22.58%(P<0.05)。治疗2周后,研究组丙氨酸转氨酶(ALT)、天门冬氨酸氨基转移酶(AST)、尿素氮(BUN)、肌酐(Cr)、胱抑素C、肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、γ-干扰素(INF-γ)、C反应蛋白(CRP)水平较治疗前降低(P<0.05),且研究组低于对照组(P<0.05)。两组患者均随访36个月,随访12个月时两组患者生存率分别为100.00%和80.65%,随访36个月时两组患者生存率分别为91.18%和29.03%,经Log Rank分析显示,两组生存率比较差异有统计学意义(P<0.05)。结论:覆膜支架腔内修复术治疗Standford B型主动脉夹层动脉瘤的疗效确切,能够改善患者肝肾功能,降低炎症反应,患者近中期随访生存率较高,其效果优于保守治疗。

Objective: To compare the effect of endovascular repair of covered stent and drug conservative treatment on Stanford B aortic dissecting aneurysm and its effects on liver and renal function, inflammatory factors and prognosis. Methods: 68 patients with Standford B aortic dissecting aneurysm who were admitted to our hospital from January 2012 to August 2014 were selected, the patients were divided into the control group and the study group according to the random number table method, 34 cases in each group. The control group was treated with drug conservative treatment after admission, the study group was treated with endovascular repair of covered stent. The mortality, reoperation or intervention rate of the two groups during hospitalization and the changes of liver and renal function and serum inflammatory factors before treatment and 2 weeks after treatment were observed. All patients were followed up for36 months, and the prognosis of the two groups was compared. Results: The rate of reoperation or intervention of the study group was2.94%, which was lower than 22.58% of the control group(P<0.05). At 2 weeks after treatment, the alanine aminotransferase(ALT),aspartate aminotransferase(AST), urea nitrogen(BUN), creatinine(Cr), Cystatin C, tumor necrosis factor-α(TNF-α), interleukin-1β(IL-1β), interferon-γ(INF-γ) and C reactive protein(CRP) levels in the study group were lower than before treatment(P<0.05), and the study group was lower than that of the control group(P<0.05). The two groups were followed up for 36 months, and the survival rates of the two groups were 100.00% and 80.65% at 12 months of follow-up respectively, the survival rates of the two groups were 91.18% and29.03% at 36 months of follow-up respectively. Log Rank analysis showed that there was a significant difference in the survival rate of the two groups(P<0.05). Conclusion: The treatment of Standford B aortic dissecting aneurysm with membrane covered stent repair has effect, it can improve the liver and renal function and reduce the inflammatory response, the survival rate of the patients is higher in the middle period, and the effect is better than that of the conservative treatment.