The Study Of The Clinical Features Of Aortic Dissection

Objective To investigate the clinical features and time distribution in the onset of aortic dissection(AD).Methods The retrospective cross-sectional study was conducted.The clinical data including gender,age,type of Stanford,initial symptom,complication,past medical history and onset time of AD of 476 cases of AD from January 2009 to June 2017 in the First Affiliated Hospital of Anhui Medical University were collected.The cases were divided by the following criteria: gender,age [young-age(<45 years),middle-age(45~59 years)and old-age(?60 years)],Stanford types(type A and type B),hypertension and non-hypertension.All variables were analyzed by circulardistribution statistics to illuminate the features of time distribution in the onset of Aortic Dissection(monthly rhythm and circadian rhythm).Observation parameters:(1)The features of distribution of the clinical data,including gender,age,type of Stanford,initial symptom,complication and past medical history.(2)The features of time distribution:(1)Time distribution of the total sample.(2)Time distribution of subgroups with different gender.(3)Time distribution of subgroups with different age.(4)Time distribution of subgroups with different Stanford types.(5)Time distribution of subgroups with(non)hypertension.Measurement data with normal distribution were represented as (?)±S and enumeration data were described as constituent ratio.Taking P<0.05 for the difference was satistically significant.Results 1.Clinical data:(1)Gender distribution:there were 363 male patients and 113 female patients,male:female =3:1.(2)Age distribution:the minimum age was 21,the maximum age was 93 and the average age was 56.70±12.92.There were 213 patients in the old-age subgroup,accounting for 44.8%;180 patients in the middle age subgroup,accounting for 37.8%;83 patients in the youth subgroup,accounting for 17.4%.(3)Type of Stanford distribution: there were 117 patients in the type A Stanford subgroup and 359 patients in the type B Stanford subgroup,type A: type B = 1:3.(4)Initial symptom distribution: there were 359 patients with chest pain,accounting for 75.4%;74 patients with abdominal pain,accounting for 15.5%;18 patients with dorsodynia,accounting for 3.8%;14 patients with faint,accounting for 2.9%;4 patients with pain of lower extremity,accounting for 0.9%;2 patients with fever and 5 patients with cough,accounting for 1.5%.(5)Complication distribution: there were 342 patients with hypertension,accounting for 71.8%;145 patients atherosclerosis,accounting for 30.5%;2 patients with Marfan syndrome,accounting for 0.5%.(6)Past medical history: there were 152 patients with smoking history,accounting for 31.9%;174 patients with history of alcohol intake,accounting for 36.6%.2.The features of time distribution:(1)Time distribution of the total sample:the tatol sample had the monthly rhythm and circadian rhythm(Z=14.79,31.60,P<0.05)?The months with the maximum and minimum number cases are November(59 cases)and August(24 cases)respectively,the peak day is January 12;AD often occurred from 16:00 to 17:00(37 cases)but barely occurred from 3:00 to 4:00(8 cases),with a peak in 14:55.(2)Time distribution of subgroups with different gender: male subgroup had the monthly rhythm and circadian rhythm(Z=11.28,27.81,P<0.05);female subgroup had the monthly rhythm and circadian rhythm(Z=3.48,4.37,P<0.05).(3)Time distribution of subgroups with different age: young-age subgroup had the circadian rhythm(Z=4.29,P<0.05),the result of monthly rhythm was statistically non-significant(Z=1.33,P>0.05);middle-age subgroup had the monthly rhythm and circadian rhythm(Z=7.48,17.41,P<0.05);old-age subgroup had the monthly rhythm and circadian rhythm(Z=6.62,11.04,P<0.05).(4)Time distribution of subgroups with different Stanford types:type A subgroup had the circadian rhythm(Z=10.51,P<0.05),the result of monthly rhythm was statistically non-significant(Z=1.60,P>0.05);type B subgroup had the monthly rhythm and circadian rhythm(Z=13.94,21.70,P<0.05).(5)Time distribution of subgroups with(non)hypertension: hypertension subgroup had the monthly rhythm and circadian rhythm(Z=12.08,29.81,P<0.05).non-hypertension subgroup had the circadian rhythm(Z=3.84,P>0.05),the result of monthly rhythm was statistically non-significant(Z=4.78,P<0.05)?Conclusion 1.The elderly over 60 have the highest incidence to get the aortic dissection,males more than females,patients with type B Stanford AD more than patients with type A Stanford AD.The initial symptom is varied and the most common initial symptom is chest pain,it may be related to the rupture and the extent of the involvement of the Aortic Dissection.Hypertension is an important risk factor.2.The onset time of AD had monthly rhythm and circadian rhythm.It often occurred in cold months and afternoon.