Clinical Study Of Patients With Acute Aortic Dissection And Association Between Angiotensin-converting Enzyme I/D Polymorphism And Acute Aortic Dissection

Objective:The first part Explore different gender and age characteristics of aortic dissection and routine laboratory parameters differences, deeper understanding and awareness of acute aortic dissection in the Xinjiang region.Part II To analyze the clinical characteristics of different types of acute aortic dissection, and differences in routine laboratory parameters, Explore acute aortic dissection and acute type A aortic dissection risk factors for death, to identify high-risk groups, to help developing the best treatment plan. The third part explore association between the ACE gene I/D polymorphism and acute aortic dissection. Methods:The first part and the second part is a retrospective study, collected in our hospital from January2008to December2012423cases of acute aortic dissection patients, Compare different age groups, different genders and different types of clinical characteristics and differences in routine laboratory parameters, analyze risk factors for death.The third part is the case-control study, the case group was180cases of patients with acute aortic dissection from March2011to July2013in our hospital, Set hypertension and healthy population control group and in age, sex and ethnic matched with cases group, Genomic DNA was extracted from blood specimens, designe Primers, to Identify genotypes.. Results:The first part Patients with an average age of50.8±12.6old, high incidence age in the40-59age grup; male patients more comman (76.1%), history of hypertension were more likely (76.1%).≤40years,41-69years, and≥570years the three age groups:patients with Arteriosclerosis were more common in higher age group. With bicuspid aortic valve patients were more common in lower age group. There are no patients with bicuspid aortic valve in aging group. Each age group treatment was significantly different. Lymphocyte count and hemoglobin levels decreased significantly with increasing age. Between men and women:smokers, irritability patients were more common in men. Women with atherosclerosis more than men, and the average age higher than men.. Men dissection involving the celiac artery more than women. dissection false lumen thrombosis women more common. Men triglycerides, lymphocytes, hemoglobin, total bilirubin, creatinine, uric acid levels higher than women. Part Ⅱ AAD death multivariate analysis of risk factors show:Aortic dissection type, with hypotension or shock, neurological symptoms, irritability, limb ischemia increased uric acid was statistically significant Between Type A and type B dissection:Type B dissection with hypertension, incidence of false lumen thrombosis, average age, systolic and diastolic blood pressure, platelet levels higher than type A dissection. Type A dissection with neurological symptoms, irritability phenomenon, hypotension or shock, myocardial ischemia, cardiac tamponade, acute renal insufficiency or failure, pleural effusion, pneumonia or atelectasis, pericardial effusion, respiratory failure, D dimer body level, neutrophil count, lymphocyte count, uric acid levels and the incidence of dissection involving coronary artery and mortality more than type B dissection. Type A dissection mainly accepted surgery and drug treatment while Type B dissection is Endovascular treatment,and There are significant differences between the two.Acute type A aortic dissection death multivariate analysis of risk factors Shows that hypotension or shock, neurological symptoms, irritability, and respiratory failure at admission, uric acid increased was statistically significant.Part III Acute aortic dissection ACE DD genotype and D allele frequency is higher than the healthy control group, there was a significant difference; higher than the hypertension group, D allele frequency showed differences but the DD genotype showed no difference. Hypertension group and the healthy control group DD genotype and D allele frequencies were not different. Hypertension group and the healthy control group, there was no difference in DD genotype and D allele frequencies. Conclusion:1. the average age of patients with acute aortic dissection is young, predilection for the40-59age group; female ratio increases with age tends to decrease,Male to female ratio increases with age decrease.2. in The higher age, atherosclerosis more participated as Pathogenic factors, and in young patients with aortic dissection genetic factors as bicuspid aortic valve plays larger role.3. Men has more risk factors than women; while women patients were more arteriosclerosis, the average age is high,and long-term prognosis may be poor.4. Acute aortic dissection death multivariate analysis of risk factors show:in Stanford A dissection, hypotension or shock, neurological symptoms, limb ischemia, and uric acid (OR) is an independent risk factor for death. Irritability is a protective factor.5. Acute type A aortic dissection patients incidence of nosocomial complications is highg, inflammatory response is severe, mortality is high; While acute type B aortic dissection occurs in high age, long-term prognosis is not optimistic.6. Acute type A aortic dissection death multivariate analysis of risk factors Show hypotension or shock, neurological symptoms, respiratory failure on admission, increased uric acid is an independent risk factor of death, irritability is a protective factor.7. ACE DD genotype and D allele frequency may be the susceptibility genes of acute aortic dissection.