冠心病患者腹主动脉瘤超声筛查的临床意义研究

发布时间：2018-12-18 09:19

【摘要】：研究背景腹主动脉瘤(abdominal aortic aneurysm,AAA)是一种严重威胁生命健康的疾病。发病早期通常无明显症状,一旦疾病进展至破裂,死亡率高达80%以上[1]。既往多项随机对照研究表明,AAA患病率在4%-7.2%,对老年男性进行AAA超声筛查,AAA相关死亡率可以减少40%[2-5]。2014年欧洲心脏病协会(ESC)主动脉疾病诊疗指南建议对大于65岁的男性进行AAA超声筛查[6]。腹主动脉B超是目前公认的AAA筛查标准方法,不仅无创、操作简便,而且敏感性高(94%-100%)、特异性高(98%-100%)[7]。然而,现有的关于AAA筛查的指南推荐,都是基于欧美人群的研究得出的结论。目前研究发现,亚洲人群的AAA患病率低于欧美人群[8-10]。AAA筛查的成本—效益比受患病率的直接影响。因此,对于中国人群,有必要寻找AAA患病率更高的人群进行筛查。有研究表明,冠心病患者与非冠心病患者相比,有着较高的AAA患病率[1113]。一项关于冠心病患者中AAA患病率的荟萃分析指出,冠心病患者中AAA患病率为非冠心病患者2.4倍[14]。但目前为止,指南对于冠心病患者是否应该常规进行AAA超声筛查并无明确指出,而且对于中国人群,目前尚缺乏冠心病患者中腹主动脉瘤患病率的相关研究。因此,我们设想在冠心病患者中进行AAA筛查,可能会有更高的患病率。研究目的本研究拟通过对住院冠心病患者进行AAA超声筛查,探讨冠心病患者中AAA的患病率,分析冠心病患者共患AAA的独立预测因素,以寻找腹主动脉瘤患病更高危的人群。研究方法前瞻性连续入选2014年10月至2015年6月在广东省人民医院心内科住院行冠脉造影确诊冠心病的患者1271例,所有患者行AAA超声筛查。收集患者基线资料、冠脉造影结果、腹主动脉超声筛查结果、心脏彩超等结果。分析冠心病患者中AAA的患病率及采用多因素logistic回归分析冠心病患者中合并AAA的独立预测因素。结果本研究中,31例(2.4%)患者因肥胖或肠腔内气体干扰,无法准确测量腹主动脉最大直径而排除,最后纳入研究1240例(97.6%)患者。1240例冠心病患者中,21例患者新筛查出AAA,3例患者既往确诊AAA,合并AAA共24例,AAA患病率为1.9%(24/1240)。其中65岁以上男性冠心病患者AAA患病率为3.1%(13/422)。采用多因素logistic回归分析,年龄≥65岁(OR= 2.55;95%CI=1.04-6.26;P=0.041),吸烟史(OR=3.04;95%CI=1.18-7.82;P=0.021),高血压(OR=3.32;95%CI =1.10-9.96;P=0.033),主动脉根部直径30mm(OR =3.32;95%CI =1.44-7.67;P=0.005)为冠心病合并AAA的独立预测因素。在不含任何独立预测因素的冠心病患者中,AAA患病率为0%(0/112);在含有一个独立预测因素的冠心病患者中,AAA患病率为0.8%(3/393);在含有两个独立预测因素的冠心病患者中,AAA患病率为1.2%(6/486);在含有三个独立预测因素的冠心病患者中,AAA患病率为5.6%(12/215);在含有四个独立预测因素的冠心病患者中,AAA患病率为8.8%(3/34)。随着合并独立预测因素个数的增加,冠心病患者中AAA的患病率逐渐增加(P0.001;线性趋势检验P0.001)。结论中国人群冠心病患者中AAA的患病率可能低于欧美人群。年龄≥65岁、吸烟史、高血压、主动脉根部直径30mm为冠心病合并AAA的独立预测因素。随着合并预测因素个数的增加,冠心病患者中AAA的患病率逐渐增加。对于我国冠心病患者行AAA筛查,可考虑在含有以上预测因素的患者中进行,尤其是合并三个或以上预测因素的患者。
[Abstract]:The study of the background of abdominal aortic aneurysm (AAA) is a kind of disease which is a serious threat to life and health. The early stage of the disease usually has no obvious symptoms, and once the disease progresses to a rupture, the mortality rate is high by more than 80%[1]. A number of previous randomized controlled studies have shown that the prevalence of AAA is in the range of 4% to 7.2%, with AAA ultrasound screening for elderly men, and AAA-related mortality can be reduced by 40%[2-5]. The 2014 European Association of Cardiology (ESC) aortic disease diagnosis and treatment guide recommends an AAA ultrasound screening of men older than 65 years of age[6]. Abdominal aortic B-ultrasound is a widely accepted standard for AAA screening, which is not only invasive, simple and convenient to operate, but also has high sensitivity (94% -100%) and high specificity (98% -100%)[7]. However, the existing guidelines for AAA screening are based on the findings of the European and American population. The current study found that the prevalence of AAA in the Asian population is lower than that of the European and American population[8-10]. The cost-benefit ratio of the AAA screening is directly affected by the prevalence. Therefore, for the Chinese population, it is necessary to find a population with higher AAA prevalence for screening. A study has shown that patients with coronary heart disease have a higher prevalence of AAA compared to non-coronary heart disease patients[1113]. A meta-analysis of the prevalence of AAA in patients with coronary heart disease states that the prevalence of AAA in patients with coronary heart disease is 2.4 times that of patients with non-coronary heart disease[14]. To date, however, there is no clear indication of whether a conventional AAA ultrasound screen should be routinely performed in patients with coronary heart disease, and for the Chinese population, there is a lack of relevant research on the prevalence of abdominal aortic aneurysms in patients with coronary heart disease. Therefore, we envisage a higher prevalence of AAA screening in patients with coronary heart disease. Objective To study the prevalence of AAA in patients with coronary heart disease and to analyze the independent predictors of AAA in patients with coronary heart disease. Methods: 1271 patients with coronary heart disease were diagnosed with coronary angiography from October 2014 to June 2015, and all patients were screened by AAA. The patient's baseline data, the results of coronary angiography, the ultrasonic screening of the abdominal aorta, and the color ultrasound of the heart were collected. The prevalence of AAA in patients with coronary heart disease and the independent predictors of AAA in patients with coronary heart disease were analyzed by multi-factor logistic regression. Results In this study, 31 (2.4%) patients were unable to accurately measure the maximum diameter of the abdominal aorta due to the interference of the air in the fat or the intestinal cavity, and were included in the study of 1240 patients (97.6%). Among the 1240 patients with coronary heart disease, 21 patients newly screened the AAA, and 3 patients had previously confirmed the AAA. The prevalence of AAA in 24 patients with AAA was 1.9% (24/ 1240). The prevalence of AAA in male patients with coronary heart disease of over 65 years was 3.1% (13/ 422). A multi-factor logistic regression analysis was used, with age of 65 years (OR = 2.55; 95% CI = 1.04-6.26; P = 0.041), smoking history (OR = 3.04; 95% CI = 1.18-7.82; P = 0.021), hypertension (OR = 3.32; 95% CI = 1.10-9.96; P = 0.033), aortic root diameter 30mm (OR = 3.32; 95% CI = 1.44-7.67; P = 0.05) as an independent predictor of the combined AAA of coronary heart disease. The prevalence of AAA was 0% (0/ 112) in patients with coronary heart disease without any independent predictor. The prevalence of AAA was 0.8% (3/ 393) in patients with coronary heart disease with an independent predictor. The prevalence of AAA was 1.2% (6/ 486) in patients with coronary heart disease with two independent predictors. In patients with coronary heart disease with three independent predictors, the prevalence of AAA was 5.6% (12/ 215); in patients with coronary heart disease with four independent predictors, the prevalence of AAA was 8. 8% (3/ 34). With the increase of the number of independent predictive factors, the prevalence of AAA in patients with coronary heart disease (CHD) was gradually increased (P0.001; linear trend test, P0.01). Conclusion The prevalence of AAA in Chinese patients with coronary heart disease may be lower than that of the European and American population. The age, age of 65, smoking history, hypertension, aortic root diameter, 30mm, were independent predictors of the combined AAA of coronary heart disease. As the number of combined prediction factors increased, the prevalence of AAA in patients with coronary heart disease was increasing. For patients with coronary heart disease, AAA screening can be considered in patients with more than three predictors, especially those with three or more predictors.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4

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