摘要
目的:探索锁骨下动脉狭窄(SS)的病因分布和解剖特征,为SS的临床实践提供参考。方法:连续入组1999-03至2017-06间阜外医院外周血管病房1 793例诊断为SS的住院患者,平均年龄为(58.7±13.9)岁,男性1 166例(65.0%)。收集其基线、临床和影像学资料,并进行统计分析。结果:1 793例SS患者中,动脉粥样硬化(AS)为最常见病因(1 543/1 793,86.1%),其次为多发性大动脉炎(TA,232/1 793,12.9%),其他病因少见(18/1 793,1.0%)。>40岁和≤40岁的SS患者中,主要病因不同,前者为AS(1 529/1 594,95.9%),而后者为TA(180/199,90.5%)。且随增龄,AS所致的SS占比逐渐升高(P<0.001)。就不同性别而言,男性SS患者病因多见AS(1 120/1 543,72.6%),女性多见TA(197/232,84.9%)。AS和TA受累位置不同,病因为AS的患者中,单纯左侧、右侧及双侧同时受累比例分别为65.4%、21.9%和12.7%(左:右=3:1);而病因为TA的患者,该比例分别为52.2%、13.4%和34.5%(左:右=4:1)。病因为TA的患者SS闭塞病变的发生率显著高于病因为AS的患者(58.0%vs 19.0%),而且无论是单纯左侧(33.2%vs 17.9%)、单纯右侧(15.5%vs 2.5%)还是双侧闭塞(14.7%vs 0.5%),差异均有统计学意义(P均<0.001)。解剖特征方面,AS所致病变一般位于锁骨下动脉的近段(97.4%;其中近段病变为77.1%,近中段病变20.2%,全程病变0.1%);而TA所致病变最常位于锁骨下动脉的中段(88.5%;其中近中段病变29.5%,中远段病变31.4%,单纯中段病变为5.4%,全程病变22.1%)。结论:AS和TA是阜外医院18年来收治的SS住院患者最主要的两种病因,其中年龄和性别对SS的病因分布有很大影响。整体上AS的比例随着增龄而逐渐升高。与病因为AS的患者相比,病因为TA的患者中段病变、闭塞病变以及双侧病变均更为常见。
Objectives: Our purpose is to evaluate the etiologies and anatomic characteristics of subclavian artery stenosis(SS), and to provide useful information for improving the clinical practice of SS.Methods: 1 793 consecutive inpatients diagnosed with SS at Fuwai Hospital between March 1999 and June 2017 were included in our study. Baseline, clinical and radiologic data were collected and analyzed retrospectively.Results: Among the 1 793 patients diagnosed with SS, the number of patients with atherosclerosis(AS), Takayasu arteritis(TA) and other causes were 1 543(86.1%), 232(12.9%) and 18(1.0%), respectively. The prevalence of AS(1 529, 95.9%) increased in proportion to age in patients aged>40 years(n=1594). Male patients accounted for 72.6% of AS, while TA was mainly found in women(84.9%). In AS patients, patients with involvement of left, right and bilateral subclavian artery were 65.4%, 21.9%, and 12.7%(left : right=3 : 1), respectively. Which was 52.2%, 13.4% and 34.5%(left : right=4 : 1), respectively, in TA patients. TA patients had more occluded lesions(58.0%) compared with AS patients(19.0%, P<0.001), this was true among patients with left(33.2% vs 17.9%), right(15.5% vs 2.5%) and bilateral subclavian artery stenosis(14.7% vs 0.5%)(all P<0.001). As to the anatomic characteristics, the most frequent involved lesions of AS patients were located at the proximal segment of subclavian artery(97.4%, in which proximal, middle and entire lesion was 77.1%, 20.2% and 0.1%, respectively). For TA patients, lesion was frequently located at the middle segment of subclavian artery(88.5%,in which proximal-middle lesion accounted for 29.5%, middle-distal lesion 31.4%, entire lesion 22.1%, and isolated middle lesion 5.4%), respectively. Conclusions: AS and TA are the top two etiologies of SS in this patient cohort. Age and gender have significant impact on the distribution of etiologies of SS. Overall, there is an obvious increase with age in the proportion of AS-SS. Patients with TA usually have more middle segment lesions, percent of occlusions and bilateral subclavian involvement are also higher compared with AS patients.
作者
车武强
蒋雄京
董徽
邹玉宝
熊洪亮
陈阳
杨跃进
高润霖
CHE Wu-qiang;JIANG Xiong-jing;DONG Hui;Zou Yu-bao;XIONG Hong-liang;CHEN Yang;YANG Yue-jin;GAO Run-lin(Department of Cardiology,National Center for Cardiovasallar Diseases and Fuwai Hospital,CAMS and PUMC,Beijing (100037),China)
出处
《中国循环杂志》
CSCD
北大核心
2018年第12期1197-1202,共6页
Chinese Circulation Journal
关键词
锁骨下动脉狭窄
病因
解剖特征
年龄
性别
Subclavian artery stenosis
Etiology
Anatomic characteristic
Age
Gender
