急性胸主动脉综合征不同性别患者行胸主动脉腔内修复术的临床疗效比较研究

Comparative analysis of the clinical efficacy of thoracic endovascular aortic repair for acute thoracic aortic syndrome in patients of different genders

目的 探讨不同性别急性胸主动脉综合征患者行胸主动脉腔内修复术(TEVAR)的近远期疗效差别。方法 连续筛选2007年1月至2021年12月于北部战区总医院心血管内科住院经计算机断层扫描血管造影(CTA)确诊为急性胸主动脉综合征行TEVAR患者796例,根据入选及排除标准,最终入选634例。按性别分为男性组(n=521例)与女性组(n=113例),比较两组患者术后近期和远期的临床效果。结果 入选的634例患者中男性与女性比例为4.6∶1,两组患者平均年龄女性高于男性,差异有统计学意义(P<0.05);女性组体重指数,吸烟史、饮酒史及住院期间应用钙通道阻滞剂比例,入院舒张压,主动脉参考血管内径,支架近端平均直径,支架远端平均直径及支架长度均低于男性组,差异均有统计学意义(P均<0.05);两组患者围术期、术后1年不良事件的发生率比较,差异均无统计学意义(P均>0.05);女性组远期主动脉源性死亡率(8.8%比3.1%,P=0.017)高于男性组,差异有统计学意义。女性组远期全因死亡率(11.8%比7.2%,P=0.126)高于男性组,但差异无统计学意义;Kaplan-Meier生存分析显示,女性组远期主动脉源性死亡率高于男性组(8.8%比3.1%,Log Rank P=0.009),差异有统计学意义。结论 急性胸主动脉综合征女性患者比例低于男性,发病年龄女性大于男性,女性患者在TEVAR术中应用覆膜支架长度短于男性,术后远期主动脉源性死亡率高于男性。

Objective To investigate the short-term and long-term efficacy of thoracic endovascular aortic repair(TEVAR)in patients of different genders with acute thoracic aortic syndrome. Methods A total of 796 patients who underwent TEVAR for acute thoracic aortic syndrome diagnosed by computed tomography angiography(CTA) in the department of cardiology of the Northern Theater General Hospital from January 2007 to December 2021 were continuously screened. According to the inclusion and exclusion criteria,634 patients were finally included. According to gender,the population was divided into male group(n=521)and female group(n=113)to compare the short-term and long-term clinical effects of the two groups. Results Among the 634 patients enrolled in our center,the male to female ratio was 4.6to 1.The average age of women was higher than that of men(P<0.05),and the difference was statistically significant(P<0.05). Body mass index,smoking history,drinking history,the population of taking calcium channel blockers during hospitalization,diastolic blood pressure at admission,aortic reference vessel diameter,mean diameter of proximal stent,mean diameter of distal stent and stent length in the female group were lower than those in the male group,the differences being statistically significant(all P<0.05). There was no significant difference in the incidence of adverse events in perioperative period or 1 year after TEVAR between the two groups(all P>0.05). The long-term aortic mortality in the female group(8.8% vs. 3.1%,P=0.017)was higher than that in the male group,and the difference was statistically significant. The long-term all-cause mortality in the female group(11.8% vs. 7.2%,P=0.126)was higher than that in the male group,but the difference was not statistically significant.Kaplan-Meier survival analysis showed that the long-term aortic-derived mortality rate in the female group was higher than that in the male group(8.8% vs.3.1%,Log Rank P=0.009),and the difference was statistically significant. Conclusions The proportion of acute thoracic aortic syndrome patients in females is lower than that in males,and the onset age of females is higher than that of males. The length of covered stent in female patients during TEVAR is shorter than that in male patients,and the long-term postoperative aortic mortality in female patients is higher than that in male patients.