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Heart:主动脉夹层发病率冬高夏低,日高夜低!

2020-07-27 朱朱 中国循环杂志

急性主动脉夹层是一种危及生命的急症,患者临床预后很差,死亡率高达50%左右。因此,了解急性主动脉发病的时间生物规律,可能有助于找出其触发因素并有效预防。

急性主动脉夹层是一种危及生命的急症,患者临床预后很差,死亡率高达50%左右。因此,了解急性主动脉发病的时间生物规律,可能有助于找出其触发因素并有效预防

华中科技大学同济医学院附属同济医院心脏大血管外科魏翔等在Heart杂志上发表的一项单中心研究显示,急性主动脉夹层发病有明显的季节、月份和昼夜规律。

总体上,寒冷的冬季(12月)是急性主动脉夹层发病高峰,而夏季(6月)发病率最低。

急性主动脉夹层发病率在一周内的分布没有明显差异。

在一天当中,夜间2~3点急性主动脉夹层发病率最低,上午9:00–10:00是第一个发病小高峰,下午16:00–17:00是第二个发病大高峰。

在该研究中,34.2%的病例发生在冬季,夏季发病率最低,占14.8%。

但不同的夹层分型略有不同:Stanford B型主动脉夹层冬季发病率最高(35.8%),夏季最低(15.8%);但Stanford A型主动脉夹层发病率高峰在秋季(33.4%)和冬季(32.3%)两季,夏季依然最低(13.7%)。

性别、年龄以及高血压状态分组的亚组分析显示,除了女士和年龄<55岁的人群,主动脉夹层的发病都呈上述规律。

在女士中,凌晨5点左右主动脉夹层发病率最低,而其他人群均是凌晨2~4点发病率最低。

大多数亚组中,主动脉夹层上午发病高峰时间为8:00~10:00,但高血压患者中早晨发病高峰在7:00,年龄>55岁人群发病高峰推迟到了10:40。

大多数亚组中,主动脉夹层下午发病高峰在16:00~17:00,而女士中发病高峰大约在18:29。

研究者认为,该研究结果有助于了解主动脉夹层的触发因素,从而更好地预防这一灾难性的急症。

另外,根据主动脉夹层发病的时间生物规律,夜晚吃降压药物或抗凝药物可能更吻合每日生理波动规律,从而显着降低心血管病发病和死亡风险,这对于有高血压或动脉粥样硬化等主动脉夹层危险因素的人来说很可能有获益。

该研究纳入2048例有典型症状、于2011~2018年在武汉同济医院确诊为急性主动脉夹层的患者,其中45.7%为Stanford A型主动脉夹层,81%为男士。

患者的平均年龄为53.4岁,其中56.7%年龄<55岁;高血压和糖尿病患病率分别为60.3%和1.8%。其中,1517例患者有明确的发病时间。

原始出处:
Liangtao Xia 1, Lu Huang 2, Xin Feng 1, et al.Chronobiological patterns of acute aortic dissection in central China.Heart. 2020 Jul 13;heartjnl-2020-317009. doi: 10.1136/heartjnl-2020-317009.

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    2020-07-29 zhaojie88
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    2020-07-29 slcumt

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