【摘要】：目的:冠狀動(dòng)脈擴(kuò)張性病變(CAE,coronary artery ectasia)是一種冠狀動(dòng)脈節(jié)段或彌漫擴(kuò)張性病變,冠脈直徑大于臨近正�；騼�(nèi)徑最大冠脈血管的1.5倍時(shí)可予診斷。CAE患者容易并發(fā)外周動(dòng)靜脈擴(kuò)張,因此推測CAE可能是全身脈管系統(tǒng)擴(kuò)張性病變的表現(xiàn)形式之一。川崎病、馬方綜合征等疾病的研究中發(fā)現(xiàn)升主動(dòng)脈擴(kuò)張與CAE存在一定相關(guān)性。本研究通過比較單純CAE、CAE合并冠狀動(dòng)脈粥樣硬化性心臟病(CAD,Coronary artery disease)、單純CAD、冠脈正常組患者升主動(dòng)脈擴(kuò)張的差異來分析CAE與升主動(dòng)脈擴(kuò)張的關(guān)系。對象和方法:本文為回顧性分析。連續(xù)入選了中國醫(yī)學(xué)科學(xué)院阜外醫(yī)院2009年1月至2014年5月行冠脈造影的694例CAE患者,根據(jù)納入及排除標(biāo)準(zhǔn)篩選后,最終入組557例CAE例患者。從同時(shí)期行冠脈造影的患者中以性別、年齡、是否合并糖尿病、高血壓、高脂血癥、吸煙史等匹配對照無CAE患者共557例。收集患者基本人口學(xué)資料、升主動(dòng)脈直徑、二尖瓣返流程度、主動(dòng)脈瓣返流程度、冠脈造影結(jié)果。升主動(dòng)脈直徑(AAD ascending aorta dimension)預(yù)測值(cm)=1.52+(年齡*0.01)+(身高cm*0.01)-1*0.25(男性)/2*0.25(女性)[12],用AAD實(shí)測值/AAD預(yù)測值計(jì)算升主動(dòng)脈擴(kuò)張程度,擴(kuò)張程度1定義為升主動(dòng)脈擴(kuò)張。首先,分析CAE組、無CAE組間升主動(dòng)脈擴(kuò)張的差異;再進(jìn)行亞組分析,將單純CAE的83例歸為A組,冠脈正常83例患者為B組,CAE合并CAD共474例為C組,單純CAD共474例為D組,分析各亞組間升主動(dòng)脈擴(kuò)張的差異性。結(jié)果:CAE 組較無 CAE 組升主動(dòng)脈直徑(33.03±4.01 VS 32.12±3.7,P0.0001)、升主動(dòng)脈擴(kuò)張程度(0.95±0.12 VS 0.91±0.11,P0.0001)、升主動(dòng)脈擴(kuò)張患病率(25.85%VS 17.06%,P0.0001)均有顯著統(tǒng)計(jì)學(xué)差異。單因素分析中,CAE組并發(fā)升主動(dòng)脈擴(kuò)張的相對風(fēng)險(xiǎn)(OR)為1.70[95%CI(1.27,2.27),P0.001];調(diào)整主動(dòng)脈瓣反流、二尖瓣反流等影響升主動(dòng)脈直徑的因素后,Logistic回歸顯示OR為1.70[95%CI(1.27,2.29),P0.001]。亞組分析中,四組間升主動(dòng)脈直徑、升主動(dòng)脈擴(kuò)張程度、升主動(dòng)脈擴(kuò)張患病率、主動(dòng)脈瓣反流、二尖瓣反流存在統(tǒng)計(jì)學(xué)差異。單純CAE組、CAE合并CAD組升主動(dòng)脈擴(kuò)張程度、升主動(dòng)脈擴(kuò)張患病率均大于單純CAD組。結(jié)論:CAE患者升主動(dòng)脈擴(kuò)張患病率高于非CAE患者,提示CAE與升主動(dòng)脈擴(kuò)張相關(guān),CAE和升主動(dòng)脈擴(kuò)張可能為全身脈管系統(tǒng)擴(kuò)張性疾病的兩種表現(xiàn)。CAE合并CAD患者升主動(dòng)脈擴(kuò)張患病率與單純CAE無統(tǒng)計(jì)學(xué)差異,提示CAD不增加升主動(dòng)脈擴(kuò)張患病風(fēng)險(xiǎn)。
[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 鹵4.01 VS 32.12 鹵3.7 VS P 0.0001, and the degree of aortic dilatation was 0.95 鹵0.12 VS 0.91 鹵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 鹵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.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R543.3

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