自发性孤立性肠系膜上动脉夹层预后及其影响因素分析

Analysis of prognosis and predictors for spontaneous isolated superior mesenteric artery dissection

目的分析自发性孤立性肠系膜上动脉夹层(SISMAD)患者影像预后、临床预后的影响因素及其二者的一致性。方法回顾性分析江苏省苏北人民医院血管外科2013年至2017年147例SISMAD患者的临床资料、影像学特点及实验室指标等48项潜在影响预后的相关数据,采用logistic单因素和多因素回归模型分析影像预后和临床预后影响因素。结果随访时间平均31(6~66)个月。(1)32例(22%)患者血管完全重塑。影像预后的独立影响因素为心率(HR=0.358,P=0.031)、酗酒(HR=0.272,P=0.023)、肠系膜上动脉(SMA)正常管径(HR=2.674,P=0.047)及血栓形成(HR=0.186,P=0.009)。(2)38例(26%)患者有临床症状残留。临床预后的独立影响因素为体重指数(HR=2.735,P=0.036)、临床症状(HR=2.534,P=0.045)及SMA开口角(HR=0.418,P=0.049)。(3)89例患者影像与临床结果不一致。影响二者一致性的独立影响因素为发病症状(HR=0.288,P=0.004)及SMA正常管径(HR=2.894,P=0.016)。结论SISMAD总体预后较好,但血管完全重塑率及症状完全恢复率偏低,且影像与临床结果不一致。

Objective To analyze the prognosis and predictive factors for patients with spontaneous isolated superior mesenteric artery(SMA)dissection.Methods A total of 147 consecutive spontaneous isolated superior mesenteric areteric dissection(SISMAD)patients from 2013 to 2017 were evaluated retrospectively.48 clinical,radiological and laboratory potential prognostic factors were evaluated using univariate and multivariate Logistic regression analyses.Results The follow-up time was 6-66 months(31 months average).Complete remodeling was observed in 32 patients(22%),and the independent predictive factors were heart rate(HR=0.358,P=0.031),alcoholism(HR=0.272,P=0.023),SMA normal diameter(HR=2.674,P=0.047)and SMA thrombosis(HR=0.186,P=0.009).38 patients(26%)still have clinical symptoms and body mass index(BMI,HR=2.735,P=0.036),initial symptoms(HR=2.534,P=0.045)and aorta-SMA angle(HR=0.418,P=0.049)were demonstrated to be significant predictive factors.The radiological and clinical prognosis were inconsistent in 89 patients and associated with initial symptoms(HR=0.288,P=0.004)and SMA normal diameter(HR=2.894,P=0.016)obviously.Conclusion The overall prognosis of SISMAD was favorable.However,the rates of complete remodeling and complete recovering of symptoms were relatively low,and the radiological and clinical prognosis were inconsistent.