【摘要】 目的探讨以下肢缺血为主要临床表现的急性主动脉夹层(AAD)患者的临床特点及相关影响因素。方法选择2002年1月—2013年1月北京大学第三医院连续收治的明确诊断为AAD的患者147例,其中以下肢缺血为主要临床表现的AAD患者共19例作为下肢缺血组,从同期收治的非下肢缺血ADD患者中通过随机数字生成器方式随机抽取64例作为非下肢缺血组,对比分析两组患者的临床资料,采用多因素非条件Logistic回归分析检验以下肢缺血为主要临床表现的AAD患者的影响因素。结果以下肢缺血为主要临床表现的AAD患者占全部AAD患者的12.9%(19/147),其中52.6%(10例)被误诊。与非下肢缺血组比较,下肢缺血组背痛发生率降低(26.3%和60.9%,P<0.05),腹痛发生率升高(57.9%和26.6%,P<0.05),肠系膜缺血发生率升高(15.8%和1.6%,P<0.05),血D-二聚体水平升高〔3.76(10.39)mg/L和1.04(2.17)mg/L,P<0.05〕,Standford A型发生率升高(57.9%和29.7%,P<0.05)。多因素非条件Logistic回归分析显示背痛〔OR=0.110,95%CI(0.016,0.741)〕、血D-二聚体水平〔OR=1.111.95%CI(1.018,1.214)〕、Standford A型〔OR=5.686,95%CI(1.051,30.754)〕是以下肢缺血为主要临床表现的AAD患者的影响因素。结论以下肢缺血为主要表现的AAD并不少见,易误诊。与非下肢缺血AAD比较,下肢缺血AAD的背痛较少见,血D-二聚体水平更高,较易出现Standford A型。更多还原

【Abstract】 Objective To explore clinical characteristics of acute aortic dissection( AAD) with lower limb ischemia( LLI) as the main clinical manifestation and its related influencing factors. Methods A total of 147 patients admitted to the Third Hospital of Peking University between January 2002 and January 2013 were diagnosed as AAD,including 19 with LLI as the main clinical manifestation( LLI group),and 64 without LLI( non- LLI group). The clinical data were analyzed comparatively. Multivariate unconditional binary Logistic regression analysis was used to test the influencing factors of AAD with LLI as the main clinical manifestation. Results The AAD patients with LLI accounted for 12. 9% of all AAD patients( 19 /147),including 10 patients being misdiagnosed( 52. 6%). The incidence of back pain lower( 26. 3%,60. 9%,P < 0. 05) in LLI group than in non- LLI group,that of abdominal pain higher( 57. 9%,26. 6%,P < 0. 05),that of mesenteric ischemia higher( 15. 8%,1. 6%,P < 0. 05),serum D- dimer higher 〔3. 76( 10. 39) mg / L,1. 04( 2. 17) mg / L,P < 0. 05〕,the incidence of standford A increased( 57. 9%,29. 7%,P < 0. 05). Multivariate unconditional binary Logistic regression analysis showed that back pain〔OR = 0. 110,95% CI( 0. 016,0. 741) 〕,D- dimmer〔OR = 1. 111,95% CI( 1. 018,1. 214) 〕,Standford type A〔OR = 5. 686,95% CI( 1. 051,30. 754) 〕were the influencing factors of AAD with LLI as the main clinical manifestation. Conclusion AAD with LLI as the main clinical manifestation is not rare and easy to be misdiagnosed. Compared with non- LLI AAD,back pain of AAD with LLI is less common,D- dimmer level is higher,and Standford type A is prone to occur.更多还原