慢性肾脏病患者并发主动脉夹层临床特征分析∗

摘要

目的：分析慢性肾脏病患者中的主动脉夹层的病例特点、治疗及预后。方法：从2005年1月1日~2015年6月30日间就诊温州医科大学附属第一医院的421例主动脉夹层患者中,筛选出40例合并慢性肾脏病患者,收集其临床资料并随访其预后,同时将其与未合并慢性肾脏病的372例主动脉夹层患者的临床资料进行比较。结果：40例慢性肾脏病患者中最常见的病因为高血压良性肾小动脉硬化、慢性肾小球肾炎、痛风性肾病。其中21例接受药物保守治疗,13例接受介入治疗,6例接受手术治疗。 log-rank检验显示合并慢性肾脏病的B型主动脉夹层患者中内科保守治疗者预后差于介入治疗者(P=0.011)。与未合并慢性肾脏病的主动脉夹层患者相比,合并慢性肾脏病者高血压更加普遍(P<0.001),较少表现为突发胸背部疼痛(P=0.001),更易于因其他疾病进行影像学检查时被发现(P=0.002),更倾向于内科保守治疗(P=0.005)。结论：合并慢性肾脏病的主动脉夹层患者较少表现为突发胸背部疼痛,对慢性肾脏病患者的心血管系统疾病筛查时还需关注大动脉的病变,此类患者,尤其是B型主动脉夹层患者或需选择更积极的介入治疗以改善预后。%Objective:This study aimed to evaluate the features and therapy in aortic dissection patients with chronic kidney disease. Methods:A retrospective analysis of 421 aortic dissection patients who admitted to our hospital during January 2005 and June 2015 was performed. Forty patients [34 males;mean age, (60. 47 ± 16. 05) years] were identified as chronic kidney disease. We collected their baseline data as well as clinical features and followed up their outcomes after discharged. Then we compared them with the 372 aortic dissection patients without chronic kidney disease [268 males;mean age, (55. 73 ± 14. 71) years]. Results:The most common etiologies of these chronic kidney disease patients were glomerulonephritis, benign hypertensive nephrosclerosis and gouty ne-phropathy. Twenty-one patients were medically treated, 13 received endovascular repair and 6 were surgically treated. During the median follow-up of 20 months ( range, 1~124 months) , there were eight deaths, and one patient developed to end stage renal dis-ease. In type B aortic dissection patients with chronic kidney disease, actively treated patients ( endovascular treatment) significantly had a favorable survival (1-year survival 100% vs 60%, respectively, log-rank test P=0. 011). Compared with those without chronic kidney disease, the cases with chronic kidney disease had more hypertension (P<0. 001), less likely to present with abrupt onset pain (P=0. 001), more often diagnosed incidentally (P=0. 002) and more patients prone to medical treated (P=0. 005). Conclusion:Invasively treatment have acceptable outcomes in chronic kidney disease patients when they suffered aortic dissection and such patients had their atypical features which need the physicians pay more attention.