雌激素和年龄对女性 A 型主动脉夹层的影响研究

Effects of estrogen and age on type A aortic dissection in women

摘要

目的 探讨雌激素和年龄对女性 A 型主动脉夹层患者的影响。方法 选择2022年1月至2023年12月就诊于西安交通大学第一附属医院的 A 型主动脉夹层女性188例为研究对象,按照年龄及绝经情况,将患者分为45岁及以下未绝经低龄组、46~55岁未绝经中龄组、46~55岁绝经中龄组、56岁及以上绝经高龄组,分别比较患者一般情况、术前炎性指标、血脂指标、肝肾功能、动脉粥样硬化及假腔血栓发生率,以及术中死亡率、术后死亡率、术后30天死亡率等情况。结果 在女性 A 型主动脉夹层患者中,低龄未绝经组、中龄未绝经组、中龄绝经组、高龄绝经组的年龄(F＝210.609),以及高血压史(χ²＝14.860)、糖尿病史(χ²＝16.451)的分布比较,差异均有统计学意义(P＜0.05).进一步两两组间比较显示,中龄未绝经组与低龄未绝经组、中龄绝经组与高龄绝经组的年龄比较,差异均有统计学意义(t值分别为-10.160、-16.727,P＜0.05);中龄未绝经组与低龄未绝经组的高血压史和糖尿病史的分布比较,差异均有统计学意义(χ²值分别为6.232、5.590,P＜0.05).四组的总胆固醇、甘油三酯、白细胞、中性粒细胞、中性粒细胞/淋巴细胞、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、肌酐、尿素氮(F值分别为507.933、28.406、491.647、333.681、219.088、70.116、117.717、169.324、72.662),以及动脉粥样硬化、假腔血栓的分布(Fisher确切概率法,P值分别为＜0.001、0.006)比较,差异均有统计学意义(P＜0.05).进一步两两组间比较显示,中龄未绝经组与低龄未绝经组的白细胞、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、肌酐、尿素氮比较,差异均有统计学意义(t＝-6.412~-2.299,P＜0.05);中龄未绝经组与中龄绝经组的总胆固醇、甘油三酯、白细胞、中性粒细胞、中性粒细胞/淋巴细胞、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、肌酐、尿素氮比较,差异均有统计学意义(t＝3.544~17.020,P＜0.05);中龄绝经组与高龄绝经组的总胆固醇、甘油三酯、白细胞、中性粒细胞、中性粒细胞/淋巴细胞、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、肌酐比较,差异均有统计学意义(t＝-13.363~-3.026,P＜0.05).四组的呼吸机辅助时间比较,差异有统计学意义(F＝0.979,P＜0.05)。结论 女性 A 型主动脉夹层患者的高血压史和糖尿病史主要与年龄有关,而患者血脂、炎性细胞、肝肾功能水平、动脉粥样硬化等因素均为年龄和雌激素综合作用所致.

Abstract

Objective To investigate the effects of estrogen and age on female patients with type A aortic dissection. Methods A total of 188 female patients with type A aortic dissection treated at the First Affiliated Hospital of Xi′an Jiao Tong University from January 2022 to December 2023 were selected as the study subjects. According to age and menopausal status, the patients were divided into four groups: a low-age group (45 years and younger, premenopausal), a middle-age group (46-55 years, premenopausal), a middle-age menopausal group (46-55 years, postmenopausal), and an elderly menopausal group (56 years and older, postmenopausal). The general conditions, preoperative inflammatory indexes, blood lipid indexes, liver and kidney function, incidence of atherosclerosis and false lumen thrombosis, as well as intraoperative mortality, postoperative mortality, and 30-day postoperative mortality were compared among the groups. Results In female patients with type A aortic dissection, the comparisons of age (F＝210.609) among the low-age premenopausal group, middle-age premenopausal group, middle-age menopausal group, and elderly menopausal group, as well as the distribution of history of hypertension (χ²＝14.860) and history of diabetes (χ²＝16.451), showed statistically significant differences (P＜0.05). Further pairwise comparisons revealed statistically significant differences in age between the middle-age premenopausal group and the low-age premenopausal group, as well as between the middle-age menopausal group and the elderly menopausal group (t-values were -10.160 and -16.727, respectively, P＜0.05). Additionally, the comparisons of the distribution of hypertension history and diabetes history between the middle-age premenopausal group and the low-age premenopausal group also showed statistically significant differences (χ ² values were 6.232 and 5.590, respectively, P＜0.05). The comparisons of total cholesterol, triglycerides, white blood cell count, neutrophil count, neutrophil-to-lymphocyte ratio, alanine aminotransferase, aspartate aminotransferase, creatinine, and blood urea nitrogen among the four groups (F values were 507.933, 28.406, 491.647, 333.681, 219.088, 70.116, 117.717, 169.324 and 72.662, respectively), as well as the distribution of atherosclerosis and false lumen thrombosis (Fisher's exact tests, P values were ＜0.001 and 0.006, respectively), showed statistically significant differences (P＜0.05). Further pairwise comparisons showed that the differences in white blood cell count, alanine aminotransferase, aspartate aminotransferase, creatinine, and blood urea nitrogen between the middle-age premenopausal group and the low-age premenopausal group were statistically significant (t＝-6.412 to -2.299, P＜0.05). The differences in total cholesterol, triglycerides, white blood cell count, neutrophil count, neutrophil-to-lymphocyte ratio, alanine aminotransferase, aspartate aminotransferase, creatinine, and blood urea nitrogen between the middle-age premenopausal group and the middle-age menopausal group were also statistically significant (t＝3.544 to 17.020, P＜0.05). The differences in total cholesterol, triglycerides, white blood cell count, neutrophil count, neutrophil-to-lymphocyte ratio, alanine aminotransferase, aspartate aminotransferase, and creatinine between the middle-age menopausal group and the elderly menopausal group were statistically significant (t＝-13.363 to -3.026, P＜0.05). The comparison of ventilator-assisted time among the four groups showed statistically significant differences (F＝0.979, P＜0.05). Conclusion The history of hypertension and diabetes in female patients with type A aortic dissection is primarily related to age, while factors such as serum lipid levels, inflammatory cells, liver and kidney function, and atherosclerosis in patients are the result of the combined effects of age and estrogen.

关键词

A 型主动脉夹层 / 绝经 / 雌激素 / 年龄

Key words

type A aortic dissection / menopause / estrogen / age

参考文献

[1] Nienaber C A, Clough R E, Sakalihasan N, et al. Aortic dissection[J]. Nat Rev Dis Primers, 2016, 2: 16053.

[2] Carrel T, Sundt T M 3rd, von Kodolitsch Y, et al. Acute aortic dissection[J]. Lancet, 2023, 401(10378): 773-788.

[3] Mussa F F, Horton J D, Moridzadeh R, et al. Acute aortic dissection and intramural hematoma: a systematic review[J]. JAMA, 2016, 316(7): 754-763.

[4] 石烽, 王志维. 主动脉夹层发病相关危险因素分析[J]. 中华老年心脑血管病杂志, 2020, 22(1): 28-31.

[5] 唐鹏. 雌激素在主动脉夹层发病过程中的作用与机制研究[D]. 武汉: 武汉大学, 2016.

[6] 唐鹏, 王志维, 胡锐, 等. 雌激素受体在夹层主动脉中的表达及意义[J]. 武汉大学学报(医学版), 2016, 37(3): 472-475.

[7] 李顺清. 主动脉夹层患者性激素水平及性激素受体的表达及意义[J]. 现代中西医结合杂志, 2016, 25(24): 2679-2681.

[8] Di Losa K, Brittenham G, Pozolo C, et al. Evaluating growth patterns of abdominal aortic aneurysms among women[J]. J Vasc Surg, 2024, 80(1): 107-113.

[9] Qi X, Wang F, Chun C, et al. A validated mouse model capable of recapitulating the protective effects of female sex hormones on ascending aortic aneurysms and dissections (AADs)[J]. Physiol Rep, 2020, 8(22): e14631.

[10] 陈柄旭, 张帅, 姜萌, 等. 围绝经期女性患者躯体症状障碍的调查分析[J]. 中国妇幼健康研究, 2022, 33(4): 1-5.

[11] Brinton R D, Yao J, Yin F, et al. Perimenopause as a neurological transition state[J]. Nat Rev Endocrinol, 2015, 11(7): 393-405.

[12] Hibino M, Otaki Y, Kobeissi E, et al. Blood pressure, hypertension, and the risk of aortic dissection incidence and mortality: results from the J-SCH study, the uk biobank study, and a meta-analysis of cohort studies[J]. Circulation, 2022, 145(9): 633-644.

[13] Ansar S, Koska J, Reaven P D. Postprandial hyperlipidemia, endothelial dysfunction and cardiovascular risk: focus on incretins[J]. Cardiovasc Diabetol, 2011, 10: 61.

[14] Song J, Peng H, Lai M, et al. Relationship between inflammatory-related cytokines with aortic dissection[J]. Int Immunopharmacol, 2023, 122: 110618.

[15] 孔运. 单核细胞与高密度脂蛋白胆固醇比值对急性 A 型主动脉夹层院内死亡的预测价值[D]. 南昌: 南昌大学, 2022.

[16] 朱泓樵. 中性粒细胞-淋巴细胞比值与急性期B型主动脉夹层腔内隔绝术治疗后早期主动脉不良事件相关性研究[D]. 上海: 中国人民解放军海军军医大学, 2022.

[17] 徐国建, 邢越, 徐一丁, 等. 胸主动脉腔内修复术对累及肾动脉的胸主动脉夹层患者肾功能的影响[J]. 血管与腔内血管外科杂志, 2024, 10(1): 98-102.

基金资助

陕西省重点研发计划项目(2023GYBSFG046)