Prognostic Impact of Blood Pressure Variability on Aortic Dissection Patients After Endovascular Therapy.
Prognostic Impact of Blood Pressure Variability on Aortic Dissection Patients After Endovascular Therapy.
复制标题
血压变异性对血管内治疗后主动脉夹层患者预后的影响
DOI：
10.1097/md.0000000000001591
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发表时间：
2015-09
期刊：
影响因子：
1.6
通讯作者：
Jing Z
中科院分区：
文献类型：
--
作者：
Zhang L;Tian W;Feng R;Song C;Zhao Z;Bao J;Liu A;Su D;Zhou J;Jing Z
对2009年1月至2013年11月期间173例急性B型主动脉夹层患者的临床资料进行回顾性分析。按术前平均BPV分层，74例患者BPV高，99例BPV低。所有患者均获得技术成功。高BPV组中高血压和全身麻醉的比例显著较高（分别为70.3% vs 55.6%和77% vs 62.6%，P = 0.049和0.043）。 高BPV组的血栓相关性死亡风险明显高于低BPV组（28.4%比9.1%，P = 0.001）。 多因素Logistic回归分析发现，高血压病史可能是BPV的危险因素（95% CI：1.010-3.911），高BPV是冠心病死亡的独立预测因素（95% CI：1.671-9.587）。无论是否患有难治性高血压，高BPV亚组和低BPV亚组之间的动脉粥样硬化相关死亡率差异显著（分别为41.4% vs 14.3%和20.0% vs 7.0%，P = 0.023和0.037）。 低BPV组假腔血栓形成率在3个月（72.4 ± 17.5% vs 51.8 ± 11.6%，P <0.001）和6个月（86.4 ± 9.1% vs 69.7 ± 7.9%，P <0.001）显著高于对照组，高BPV是影响主动脉夹层预后的独立危险因素。 对BPV的进一步研究可能为主动脉夹层的防治提供新的策略。
AbstractHypertension has been deemed as a pivotal risk factor for the development of aortic dissection; however, the importance and prognostic significance of blood pressure variability (BPV) in aortic dissection are always ignored.A total of 173 acute type B aortic dissection patients were enrolled in and retrospectively reviewed between January 2009 and November 2013. There were 74 patients with high BPV and 99 with low BPV stratified by preoperative mean BPV. Technical success was achieved in all patients. The proportions of hypertension and general anesthesia were significantly higher in the high BPV group (70.3% vs 55.6% and 77% vs 62.6%, P = 0.049 and 0.043, respectively). The risk of aorta-related death in the high BPV group was apparently higher than the low BPV group (28.4% vs 9.1%, P = 0.001). By performing multivariable logistic regression, we found history of hypertension was likely to be a risk factor of BPV (95% confidence interval [CI]: 1.010–3.911), and high BPV was an independent predictor of aorta-related death (95% CI: 1.671–9.587). The difference of aorta-related mortality was pronounced between high and low BPV subgroups regardless of the refractory hypertension (41.4% vs 14.3% and 20.0% vs 7.0%, P = 0.023 and 0.037, respectively). The thrombosis ratio of false lumen was significantly higher in the low BPV group at 3-month (72.4 ± 17.5% vs 51.8 ± 11.6%, P < 0.001) and 6-month (86.4 ± 9.1% vs 69.7 ± 7.9%, P < 0.001).High BPV is an independent risk factor for the prognosis of aortic dissection. Further studies on BPV might provide new preventive and therapeutic strategies for aortic dissection.