Risk factors for aneurysm rupture in patients kept under ultrasound surveillance
Risk factors for aneurysm rupture in patients kept under ultrasound surveillance
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DOI：
10.1097/00000658-199909000-00002
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发表时间：
1999-09-01
影响因子：
9
通讯作者：
Powell, JT
中科院分区：
文献类型：
--
作者：
Brown, LC;Powell, JT
摘要背景数据英国小动脉瘤试验表明，对于直径4.0~5.5 cm的腹主动脉瘤患者，超声监测是一种安全的治疗方法，其年破裂率为1%。方法在257例患者中，年龄59~77岁的2257例患者(男性79%)，在1991年至1998年的7年随访期间，发现103例腹主动脉瘤破裂。几乎所有患者(98%)的初始动脉瘤直径在3~6 cm之间，大多数(76%)破裂发生在直径大于或等于5 cm的患者中。采用Kaplan-Meier生存分析和Cox回归分析确定与动脉瘤破裂相关的基线危险因素。结果3年后，动脉瘤破裂的年发生率为2.2%(95%可信区间为1.7~2.8)。破裂风险与女性(p<；0.001)、较大的初始动脉瘤直径(p<；0.001)、较低的FEV1(p=0.004)、当前吸烟(p=0.001)和较高的平均血压(p=0.001)独立且显著相关。年龄、体重指数、血清胆固醇浓度和踝臂压指数与动脉瘤破裂风险无关。结论在这组患者中，女性的动脉瘤破裂风险是男性的三倍。有效控制血压和戒烟可能会降低破裂的风险。
ObjectiveTo investigate risk factors associated with aneurysm rupture using patients randomized into the U.K. Small Aneurysm Trial (n = 1090) or monitored for aneurysm growth in the associated study(n = 1167),Summary Background DataThe U.K. Small Aneurysm Trial has shown that ultrasound surveillance is a safe management option for patients with small abdominal aortic aneurysms (4.0 to 5.5 cm in diameter), with an annual rupture rate of 1%.MethodsIn the cohort of 2257 patients (79% male), aged 59 to 77 years, 103 instances of abdominal aortic aneurysm rupture were identified during the 7-year period of follow-up (1991-1998). Almost all patients (98%) had initial aneurysm diameters in the range of 3 to 6 cm, and the majority of ruptures (76%) occurred in patients with aneurysms greater than or equal to 5 cm in diameter. Kaplan-Meier survival and Cox regression analysis were used to identify baseline risk factors associated with aneurysm rupture.ResultsAfter 3 years, the annual rate of aneurysm rupture was 2.2% (95% confidence interval 1.7 to 2.8). The risk of rupture was independently and significantly associated with female sex (p < 0.001), larger initial aneurysm diameter (p < 0.001), lower FEV1 (p = 0.004), current smoking (p = 0.001), and higher mean blood pressure (p = 0.01). Age, body mass index, serum cholesterol concentration, and ankle/brachial pressure index were not associated with an increased risk of aneurysm rupture.ConclusionsWithin this cohort of patients, women had a threefold higher risk of aneurysm rupture than men. Effective control of blood pressure and cessation of smoking are likely to diminish the risk of rupture.