冠状动脉扩张性疾病中升主动脉扩张的差异分析

发布时间：2018-10-31 17:33

【摘要】：目的:冠状动脉扩张性病变(CAE,coronary artery ectasia)是一种冠状动脉节段或弥漫扩张性病变,冠脉直径大于临近正常或内径最大冠脉血管的1.5倍时可予诊断。CAE患者容易并发外周动静脉扩张,因此推测CAE可能是全身脉管系统扩张性病变的表现形式之一。川崎病、马方综合征等疾病的研究中发现升主动脉扩张与CAE存在一定相关性。本研究通过比较单纯CAE、CAE合并冠状动脉粥样硬化性心脏病(CAD,Coronary artery disease)、单纯CAD、冠脉正常组患者升主动脉扩张的差异来分析CAE与升主动脉扩张的关系。对象和方法:本文为回顾性分析。连续入选了中国医学科学院阜外医院2009年1月至2014年5月行冠脉造影的694例CAE患者,根据纳入及排除标准筛选后,最终入组557例CAE例患者。从同时期行冠脉造影的患者中以性别、年龄、是否合并糖尿病、高血压、高脂血症、吸烟史等匹配对照无CAE患者共557例。收集患者基本人口学资料、升主动脉直径、二尖瓣返流程度、主动脉瓣返流程度、冠脉造影结果。升主动脉直径(AAD ascending aorta dimension)预测值(cm)=1.52+(年龄*0.01)+(身高cm*0.01)-1*0.25(男性)/2*0.25(女性)[12],用AAD实测值/AAD预测值计算升主动脉扩张程度,扩张程度1定义为升主动脉扩张。首先,分析CAE组、无CAE组间升主动脉扩张的差异;再进行亚组分析,将单纯CAE的83例归为A组,冠脉正常83例患者为B组,CAE合并CAD共474例为C组,单纯CAD共474例为D组,分析各亚组间升主动脉扩张的差异性。结果:CAE 组较无 CAE 组升主动脉直径(33.03±4.01 VS 32.12±3.7,P0.0001)、升主动脉扩张程度(0.95±0.12 VS 0.91±0.11,P0.0001)、升主动脉扩张患病率(25.85%VS 17.06%,P0.0001)均有显著统计学差异。单因素分析中,CAE组并发升主动脉扩张的相对风险(OR)为1.70[95%CI(1.27,2.27),P0.001];调整主动脉瓣反流、二尖瓣反流等影响升主动脉直径的因素后,Logistic回归显示OR为1.70[95%CI(1.27,2.29),P0.001]。亚组分析中,四组间升主动脉直径、升主动脉扩张程度、升主动脉扩张患病率、主动脉瓣反流、二尖瓣反流存在统计学差异。单纯CAE组、CAE合并CAD组升主动脉扩张程度、升主动脉扩张患病率均大于单纯CAD组。结论:CAE患者升主动脉扩张患病率高于非CAE患者,提示CAE与升主动脉扩张相关,CAE和升主动脉扩张可能为全身脉管系统扩张性疾病的两种表现。CAE合并CAD患者升主动脉扩张患病率与单纯CAE无统计学差异,提示CAD不增加升主动脉扩张患病风险。
[Abstract]:Objective: coronary artery dilated lesion (CAE,coronary artery ectasia) is a kind of coronary artery segmental or diffuse dilated lesion. The diagnosis can be made when the diameter of coronary artery is greater than 1.5 times of normal or maximal coronary artery diameter. Patients with CAE are easy to be complicated with peripheral arteriovenous dilatation, so it is speculated that CAE may be one of the manifestations of dilated lesions of systemic vascular system. Ascending aorta dilatation was associated with CAE in the study of Kawasaki disease and Marquis syndrome. The purpose of this study was to investigate the relationship between ascending aortic dilatation and CAE,CAE combined with coronary atherosclerotic heart disease (CAD,Coronary artery disease),) in patients with normal coronary artery disease (CAD,Coronary artery disease),). Objects and methods: this paper is a retrospective analysis. From January 2009 to May 2014, 694 patients with CAE underwent coronary angiography in Fuwei Hospital of Chinese Academy of Medical Sciences. According to the criteria of inclusion and exclusion, 557 patients with CAE were selected. A total of 557 patients without CAE were matched by sex, age, diabetes mellitus, hypertension, hyperlipidemia and smoking history. Basic demographic data, ascending aorta diameter, mitral regurgitation degree, aortic regurgitation degree and coronary angiography results were collected. The (AAD ascending aorta dimension) predictive value of ascending aorta diameter (cm) = 1.52 (age * 0.01) (height cm*0.01) -10.25 (M) / 2C 0.25 (F) [12]. The degree of ascending aorta dilatation was calculated by AAD measured value / AAD predictive value, and the degree of dilatation was defined as ascending aortic dilatation. First, the difference of ascending aorta dilation between CAE group and no CAE group was analyzed. After subgroup analysis, 83 cases of simple CAE were classified into group A, 83 cases of normal coronary artery were group B, 474 cases of CAE combined with CAD were group C, and 474 cases of CAD alone were group D. the difference of ascending aorta dilatation among each subgroup was analyzed. Results: the diameter of ascending aorta in CAE group was 33.03 卤4.01 VS 32.12 卤3.7 VS P 0.0001, and the degree of aortic dilatation was 0.95 卤0.12 VS 0.91 卤0.11 VS P 0.0001 in CAE group. The prevalence of ascending aortic dilatation (25.85%VS 17.06) was significantly different (P 0.0001). In univariate analysis, the relative risk of ascending aortic dilatation in CAE group was 1.70 [95%CI (1.27 卤2.27), P0.001]. After adjusting aortic regurgitation and mitral regurgitation, OR was 1.70 [95%CI (1.272.29), P0.001]. In subgroup analysis, there were significant differences in the diameter of ascending aorta, the degree of aortic dilatation, the prevalence of ascending aortic dilatation, aortic regurgitation and mitral regurgitation among the four groups. The degree of ascending aorta dilatation and the prevalence of ascending aortic dilatation in CAE combined with CAD group were higher than those in CAD group. Conclusion: the prevalence of ascending aortic dilatation in CAE patients is higher than that in non-CAE patients, suggesting that CAE is associated with ascending aortic dilatation. CAE and ascending aorta dilatation may be two manifestations of systemic vascular system dilation disease. The prevalence of ascending aortic dilatation in CAE patients with CAD is not significantly different from that in CAE alone, suggesting that CAD does not increase the risk of ascending aortic dilatation.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R543.3

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