背景:需要对主动脉夹层(AD)进行基于人群的流行病学研究。本研究旨在报道临床特征,发病率,以及1996年至2016年丹麦医院收治的A型AD(TAAD)或B型AD(TBAD)成年患者的死亡率.
方法:我们在全国范围内进行了一次,基于人群的登记研究。在国际疾病分类中登记的所有AD病例,丹麦国家患者登记处的第十次修订代码在入院时具有可用的医疗记录进行了验证。全国卫生登记处之间的数据合并,包括死亡原因登记处。已验证的AD患者在性别和年龄上与丹麦普通人群中的高血压患者匹配为1:10。
结果:在5018例登记的AD病例中,4183例接受审查,3023例(60.2%)被确认为AD。排除后,验证TAAD和TBAD的分布分别为1620(60.5%)和1059(39.5%;P<0.001),67.5%和67.0%的患者为男性,夹层的平均年龄为63.5±12.9岁和67.5±12.2岁(P<0.001),分别。TAAD最常见的合并症是高血压(55.2%),胸主动脉瘤(14.6%),和慢性阻塞性肺疾病(13.1%);对于TBAD,最普遍的合并症是高血压(64.1%),任何位置的主动脉瘤(7.5%至12.0%),和慢性阻塞性肺疾病(15.7%)。总平均年发病率为4.2/10万患者年。TAAD(2.2/100000)的发病率明显高于TBAD(1.5/100000;P<0.001)。经过验证的TAAD和TBAD的30天死亡率分别为22.0%和13.9%(P<0.001),分别,随着时间的推移或性别之间没有显著变化。调整后的TAAD和TBAD的5年总死亡率为风险比3.2(2.9至3.5;P<0.001;主动脉相关死亡原因,57.0%)和风险比2.1(1.9至2.4;P<0.001;主动脉相关死亡原因,42.8%),分别,与普通高血压人群相比。在解剖后存活30天的患者中,调整后的5年总死亡率为风险比1.1(1.0至1.3;P=0.12;主动脉相关死亡原因,23.2%)和风险比1.4(1.2至1.6;P<0.001;主动脉相关死亡原因,25.6%)对于TAAD和TBAD,分别。
结论:高血压,主动脉瘤,和慢性阻塞性肺疾病是最常见的合并症。随着时间的推移,30天的死亡频率是一致的,性别之间没有显着差异。TAAD的5年死亡率高于TBAD。如果病人在解剖后存活了30天,TAAD患者的死亡率与普通高血压人群相当,但TBAD患者的死亡率明显较高。
Population-based epidemiologic studies of aortic dissections (ADs) are needed. This study aimed to report clinical characteristics, incidences, and mortality rates for adult patients admitted to Danish hospitals with type A AD (TAAD) or type B AD (TBAD) from 1996 through 2016.
We conducted a nationwide, population-based register study. All cases of AD registered with International Classification of Diseases, Tenth Revision codes in the Danish National Patient Registry at time of admission to a hospital with available medical records underwent validation. Data were merged between nationwide health registries including the cause of death registry. Patients with validated AD were matched 1:10 on sex and age with patients with hypertension from the general Danish population.
Of 5018 registered cases of AD, 4183 cases underwent review and 3023 (60.2%) were validated as AD. After exclusions, the distribution of validated TAAD and TBAD was 1620 (60.5%) and 1059 (39.5%; P<0.001), 67.5% and 67.0% of patients were men, and mean ages at dissection were 63.5±12.9 and 67.5±12.2 years (P<0.001), respectively. The most prevalent comorbidities for TAAD were hypertension (55.2%), thoracic aortic aneurysms (14.6%), and chronic obstructive pulmonary disease (13.1%); for TBAD, the most prevalent comorbidities were hypertension (64.1%), aortic aneurysms at any location (7.5% to 12.0%), and chronic obstructive pulmonary disease (15.7%). The overall mean annual incidence rate was 4.2/100 000 patient-years. Incidence was significantly higher for TAAD (2.2/100 000) compared with TBAD (1.5/100 000; P<0.001). The 30-day mortality rates for validated TAAD and TBAD were 22.0% and 13.9% (P<0.001), respectively, with no significant changes over time or between sexes. Adjusted 5-year overall mortality rates for TAAD and TBAD were hazard ratio 3.2 (2.9 to 3.5; P<0.001; aortic-related cause of death, 57.0%) and hazard ratio 2.1 (1.9 to 2.4; P<0.001; aortic-related cause of death, 42.8%), respectively, compared with the general hypertensive population. Among patients who survived 30 days from dissection, the adjusted 5-year overall mortality rates were hazard ratio 1.1 (1.0 to 1.3; P=0.12; aortic-related cause of death, 23.2%) and hazard ratio 1.4 (1.2 to 1.6; P<0.001; aortic-related cause of death, 25.6%) for TAAD and TBAD, respectively.
Hypertension, aortic aneurysms, and chronic obstructive pulmonary disease were the most prevalent comorbidities. The 30-day mortality frequencies were consistent over time with no significant differences between sexes. The 5-year mortality rate was higher for TAAD than TBAD. If the patient survived 30 days from dissection, the mortality rate for patients with TAAD was comparable with that of the general hypertensive population, but the mortality rate was significantly higher in patients with TBAD.