非传染性胸前动脉炎的长期结果和预后
Olivier Espitia1, Patrick Bruneval2, Morgane Assaraf3
1Nantes Université, CHU Nantes, Department of Vascular Medicine, Nantes, France; l'institut du thorax, INSERM UMR1087/CNRS UMR 6291, Team III Vascular & Pulmonary diseases, Nantes, France.
Journal of the American College of Cardiology
|September 6, 2023
概括
非传染性胸腔大心炎显著影响患者,82%的患者在10年内出现血管并发症. 识别高风险因素对于管理这种大动脉炎症和预防进一步的手术至关重要.
科学领域:
- 血管外科 血管外科
- 类风湿病学 类风湿病学
- 心脏病学 心脏病学
背景情况:
- 主动脉炎,以主动脉炎症为特征,通常源于大血管血管.
- 对于主动脉炎患者的长期结果仍然不完全理解.
- 非传染性胸腔大心炎是一个重大的临床挑战.
研究的目的:
- 评估患有非传染性手术胸腔大心炎的患者的长期预后和结果.
- 为了确定血管并发症的预测因素,以及在这个患者队列中需要重新干预的需要.
主要方法:
- 一项回顾性多中心研究,涉及5,666名接受胸前动脉外科手术的患者.
- 对217名被诊断患有非传染性胸腔大心炎的患者的分析,包括临床隔离性大心炎,巨细胞动脉炎,塔卡亚苏动脉炎和全身自身免疫性疾病.
- 多变量分析以评估与血管并发症和随后的血管手术相关的因素.
主要成果:
- 血管并发症的10年累积发病率为82.1%,第二次血管手术的需要为42.6%.
- 大动脉主动脉炎独立预测了血管并发症.
- 下降胸腔大炎和大裂解与需要第二次血管手术的风险更高有关,而诊断后使用他类药物具有保护性.
- 16.1%的临床隔离性主动脉炎患者出现了全身性炎症性疾病特征,16%的患者在平均3.9年的随访期间死亡.
结论:
- 非传染性胸腔大心炎带有长期血管并发症的高风险,在十年内影响超过80%的患者.
- 特定的解剖位置 (大动脉,下降胸前大动脉) 和潜在的条件 (大动脉剖析) 是不良结果的关键预测因素.
- 风险分层和有针对性的干预措施,可能包括他类药物治疗,对于改善非传染性胸腔大心炎患者的预后至关重要.
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