摘要目的:探讨合并高血压的Stanford B型主动脉夹层（TBAD）患者的临床特征，以及短期和长期预后影响因素。方法:连续纳入2014年1月至2018年12月在襄阳市中心医院接受胸主动脉腔内修复术（TEVAR）的TBAD患者，通过病案管理系统采集患者入院时的基线资料，包括性别、年龄、既往疾病史（高血压、糖尿病、冠心病）、吸烟史、饮酒史、疼痛持续时间，生命体征〔心率（HR）、收缩压（SBP）、舒张压（DBP）〕，实验室检查指标〔白细胞计数（WBC）、血小板计数（PLT）、中性粒细胞/淋巴细胞比值（NLR）、血肌酐（SCr）、C-反应蛋白（CRP）、D-二聚体、升主动脉直径〕等。分析合并高血压TBAD患者的临床特征，并分别采用Logistic回归模型和Cox比例风险模型分析高血压对TBAD患者TEVAR术后短期、长期全死因死亡的影响。结果:纳入227例TBAD患者中，合并高血压者160例（70.5%），未合并高血压者67例（29.5%）。合并高血压TBAD患者的平均年龄，合并糖尿病、冠心病的比例，入院时SBP、DBP及SCr水平均高于未合并高血压TBAD患者〔年龄（岁）：53.1±11.9比42.8±14.1，合并糖尿病：8.8%比1.5%，合并冠心病：6.3%比0%，SBP（mmHg，1 mmHg＝0.133 kPa）：147.9±18.1比136.9±15.2，DBP（mmHg）：93.9±11.9比89.1±13.8，SCr（μmol/L）：97.8±25.4比89.8±23.6，均 P<0.05〕。合并高血压TBAD组患者住院期间的短期病死率明显高于未合并高血压TBAD组〔6.3%（10/160）比0%（0/67）， χ2＝4.386， P＝0.036〕。227例TBAD患者术后随访3~66个月，中位随访时间25个月。合并与未合并高血压TBAD组患者出院随访期间的长期病死率差异无统计学意义〔13.1%（21/160）比9.0%（6/67）， χ2＝0.784， P＝0.376〕。进一步多因素Logistic回归分析和Cox回归分析并未发现高血压是影响TBAD患者术后短期、长期死亡的独立危险因素〔优势比（ OR）和95%可信区间（95% CI）分别为13.477（0.541~330.215）、1.012（0.990~1.035），均 P>0.05〕；而年龄、HR是影响TBAD患者术后短期病死率的独立危险因素〔 OR和95% CI分别为15.287（1.051~226.415）、0.026（0.002~0.840），均 P<0.05〕，年龄、PLT、D-二聚体是影响TBAD患者术后长期病死率的独立危险因素〔 OR和95% CI分别为1.808（1.205~2.711）、0.555（0.333~0.924）、1.482（1.035~2.122），均 P<0.05〕。 结论:合并高血压TBAD患者存在年龄更大，合并糖尿病、冠心病比例更高等特点；但高血压并不是TBAD患者术后短期、长期死亡的独立危险因素。

abstractsObjective:To investigate the clinical characteristics as well as short-term and long-term prognostic factors of patients with Stanford type B aortic dissection (TBAD) with hypertension.Methods:Patients with TBAD who received thoracic endovascular aortic repair (TEVAR) admitted to Xiangyang Central Hospital from January 2014 to December 2018 were enrolled. The baseline data of patients admitted to the hospital were collected through the case management system, including gender, age, underlying diseases (hypertension, diabetes, coronary heart disease), smoking history, drinking history, duration of pain, vital signs at admission [heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP)], laboratory results [white blood cell count (WBC), platelet count (PLT), neutrophil/lymphocyte ratio (NLR), serum creatinine (SCr), C-reactive protein (CRP), D-dimer, ascending aorta diameter], etc. The clinical characteristics of TBAD patients with hypertension were analyzed. Logistic regression model and Cox proportional risk model were used to analyze the impact of hypertension on the short-term and long-term all-cause deaths after TEVAR in TBAD patients.Results:Among 227 TBAD patients, 160 cases (70.5%) were complicated with hypertension, while 67 cases (29.5%) were not. The average age, the proportion of diabetes and coronary heart disease, and the level of SBP, DBP and SCr at admission of TBAD patients with hypertension were higher than those of TBAD without hypertension [age (years old): 53.1±11.9 vs. 42.8±14.1, combined with diabetes: 8.8% vs. 1.5%, combined with coronary heart disease: 6.3% vs. 0%, SBP (mmHg, 1 mmHg = 0.133 kPa): 147.9±18.1 vs. 136.9±15.2, DBP (mmHg): 93.9±11.9 vs. 89.1±13.8, SCr (μmol/L): 97.8±25.4 vs. 89.8±23.6, all P < 0.05]. The short-term mortality of TBAD with hypertension group was significantly higher than that of TBAD without hypertension group [6.3% (10/160) vs. 0% (0/67), χ2 = 4.386, P = 0.036]. 227 patients with TBAD were followed up for 3-66 months, with a median follow-up time of 25 months. There was no significant difference in long-term mortality between TBAD patients with and without hypertensive during discharge follow-up [13.1% (21/160) vs. 9.0% (6/67), χ2 = 0.784, P = 0.376]. Further multivariate Logistic regression analysis and Cox regression analysis did not indicate that hypertension was an independent risk factor for short-term and long-term death in TBAD patients [odds ratio ( OR) and 95% confidence interval (95% CI) were 13.477 (0.541-330.215), 1.012 (0.990-1.035), both P > 0.05]. Age and HR were independent risk factors for the short-term mortality of TBAD patients [ OR and 95% CI were 15.287 (1.051-226.415), 0.026 (0.002-0.840), both P < 0.05]. Age, PLT and D-dimer were independent risk factors for the long-term mortality of TBAD patients [ OR and 95% CI were 1.808 (1.205-2.711), 0.555 (0.333-0.924), 1.482 (1.035-2.122), respectively, all P < 0.05]. Conclusions:The TBAD patients with hypertension have older age, high rates of diabetes or coronary heart disease. However, hypertension is not an independent risk factor for short-term and long-term mortality in TBAD patients.