冠心病患者腹主動脈瘤超聲篩查的臨床意義研究
發(fā)布時間：2018-12-18 09:19
【摘要】：研究背景腹主動脈瘤(abdominal aortic aneurysm,AAA)是一種嚴重威脅生命健康的疾病。發(fā)病早期通常無明顯癥狀,一旦疾病進展至破裂,死亡率高達80%以上[1]。既往多項隨機對照研究表明,AAA患病率在4%-7.2%,對老年男性進行AAA超聲篩查,AAA相關(guān)死亡率可以減少40%[2-5]。2014年歐洲心臟病協(xié)會(ESC)主動脈疾病診療指南建議對大于65歲的男性進行AAA超聲篩查[6]。腹主動脈B超是目前公認的AAA篩查標準方法,不僅無創(chuàng)、操作簡便,而且敏感性高(94%-100%)、特異性高(98%-100%)[7]。然而,現(xiàn)有的關(guān)于AAA篩查的指南推薦,都是基于歐美人群的研究得出的結(jié)論。目前研究發(fā)現(xiàn),亞洲人群的AAA患病率低于歐美人群[8-10]。AAA篩查的成本—效益比受患病率的直接影響。因此,對于中國人群,有必要尋找AAA患病率更高的人群進行篩查。有研究表明,冠心病患者與非冠心病患者相比,有著較高的AAA患病率[1113]。一項關(guān)于冠心病患者中AAA患病率的薈萃分析指出,冠心病患者中AAA患病率為非冠心病患者2.4倍[14]。但目前為止,指南對于冠心病患者是否應該常規(guī)進行AAA超聲篩查并無明確指出,而且對于中國人群,目前尚缺乏冠心病患者中腹主動脈瘤患病率的相關(guān)研究。因此,我們設想在冠心病患者中進行AAA篩查,可能會有更高的患病率。研究目的本研究擬通過對住院冠心病患者進行AAA超聲篩查,探討冠心病患者中AAA的患病率,分析冠心病患者共患AAA的獨立預測因素,以尋找腹主動脈瘤患病更高危的人群。研究方法前瞻性連續(xù)入選2014年10月至2015年6月在廣東省人民醫(yī)院心內(nèi)科住院行冠脈造影確診冠心病的患者1271例,所有患者行AAA超聲篩查。收集患者基線資料、冠脈造影結(jié)果、腹主動脈超聲篩查結(jié)果、心臟彩超等結(jié)果。分析冠心病患者中AAA的患病率及采用多因素logistic回歸分析冠心病患者中合并AAA的獨立預測因素。結(jié)果本研究中,31例(2.4%)患者因肥胖或腸腔內(nèi)氣體干擾,無法準確測量腹主動脈最大直徑而排除,最后納入研究1240例(97.6%)患者。1240例冠心病患者中,21例患者新篩查出AAA,3例患者既往確診AAA,合并AAA共24例,AAA患病率為1.9%(24/1240)。其中65歲以上男性冠心病患者AAA患病率為3.1%(13/422)。采用多因素logistic回歸分析,年齡≥65歲(OR= 2.55;95%CI=1.04-6.26;P=0.041),吸煙史(OR=3.04;95%CI=1.18-7.82;P=0.021),高血壓(OR=3.32;95%CI =1.10-9.96;P=0.033),主動脈根部直徑30mm(OR =3.32;95%CI =1.44-7.67;P=0.005)為冠心病合并AAA的獨立預測因素。在不含任何獨立預測因素的冠心病患者中,AAA患病率為0%(0/112);在含有一個獨立預測因素的冠心病患者中,AAA患病率為0.8%(3/393);在含有兩個獨立預測因素的冠心病患者中,AAA患病率為1.2%(6/486);在含有三個獨立預測因素的冠心病患者中,AAA患病率為5.6%(12/215);在含有四個獨立預測因素的冠心病患者中,AAA患病率為8.8%(3/34)。隨著合并獨立預測因素個數(shù)的增加,冠心病患者中AAA的患病率逐漸增加(P0.001;線性趨勢檢驗P0.001)。結(jié)論中國人群冠心病患者中AAA的患病率可能低于歐美人群。年齡≥65歲、吸煙史、高血壓、主動脈根部直徑30mm為冠心病合并AAA的獨立預測因素。隨著合并預測因素個數(shù)的增加,冠心病患者中AAA的患病率逐漸增加。對于我國冠心病患者行AAA篩查,可考慮在含有以上預測因素的患者中進行,尤其是合并三個或以上預測因素的患者。
[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.
【學位授予單位】：南方醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R541.4
本文編號：2385638
[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.
【學位授予單位】：南方醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R541.4
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