主动脉夹层发病相关危险因素分析

Risk factors for onset of aortic dissection diseases

目的分析主动脉夹层(AD)发病相关危险因素的流行病学特点,以指导临床诊治。方法选择2017年1月~2019年6月我中心收治因胸痛就诊入院的患者733例,根据最终诊断,将确诊AD患者328作为病例组,非AD患者405例作为对照组,回顾性分析比较2组患者一般资料、既往病史和实验室指标,多因素logistic回归分析AD的影响因素。结果与对照组比较,病例组高血压、动脉粥样硬化、马方综合征、白塞病、主动脉瓣二叶畸形、大动脉炎、吸烟、饮酒比例、TC、TG、LDL-C水平明显升高,载脂蛋白A-Ⅰ和HDL-C水平明显降低(P<0.05,P<0.01)。logistic回归分析显示,高血压(OR=5.334,95%CI:3.757~7.574,P=0.000)、马方综合征(OR=4.681,95%CI:2.893~7.576,P=0.000)、主动脉瓣二叶畸形(OR=2.365,95%CI:1.476~3.812,P=0.000)、吸烟(OR=1.908,95%CI:1.164~3.126,P=0.010),载脂蛋白A-Ⅰ(OR=0.524,95%CI:0.320~0.859,P=0.010)和HDL-C(OR=0.187,95%CI:0.132~0.266,P=0.000)是AD的影响因素。结论高血压、马方综合征、主动脉瓣二叶畸形、吸烟是AD的独立危险因素,载脂蛋白A-Ⅰ和HDL-C是AD发病的独立保护因素。

Objective To analyze the epidemiological characteristics of risk factors for the onset of aortic dissection(AD)diseases in order to guide its clinical diagnosis and treatment.Methods Seven hundred and thirty-three chest pain patients admitted to our hospital from January 2017 to June 2019 were divided into AD group(n=328)and control group(n=405).Their general data,past medical history and laboratory parameters were compared and retrospectively analyzed.The influencing factors of AD diseases were analyzed by multivariate logistic regression analysis.Results The incidence of hypertension,atherosclerosis,Marfan syndrome,Behcet’s disease,bicuspid aortic valve deformity,aortitis,the ratio of smoking and alcohol drinking,the serum levels of TC,TG and LDL-C were significantly higher while the serum levels of apolipoprotein A-Ⅰand HDL-C were significantly lower in AD group than in control group(P<0.05,P<0.01).Logistic regression analysis showed that hypertension,Marfan syndrome,bicuspid aortic valve deformity,smoking,serum apolipoprotein A-Ⅰ and HDL-C level were the influencing factors of AD diseases(OR=5.334,95%CI:3.757-7.574,P=0.000;OR=4.681,95%CI:2.893-7.576,P=0.000;OR=2.365,95%CI:1.476-3.812,P=0.000;OR=1.908,95%CI:1.164-3.126,P=0.010;OR=0.524,95%CI:0.320-0.859,P=0.010;OR=0.187,95%CI:0.132-0.266,P=0.000).Conclusion Hypertension,Marfan syndrome,bicuspid aortic valve deformity and smoking are the independent risk factors for AD diseases while serum apolipoprotein A-Ⅰand HDL-C levels are the independent protective factors for AD diseases.