运动诱发的胸主动脉夹层的诊治体会_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

刘一人 , 郭建明 , 孟良 , 徐泽勤 , 佟铸 , 谷涌泉 ,  郭连瑞

首都医科大学宣武医院血管外科（北京 100053）;

Corresponding author：

郭连瑞, Email: 1044832160@qq.com

Keywords：

胸主动脉夹层; 腔内治疗; 支架置入; 运动

DOI：

10.7507/1007-9424.202007125

Video：

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目的总结运动相关性胸主动脉夹层的临床和影像学特点以及腔内治疗的可行性。方法回顾性分析首都医科大学宣武医院（简称“我院”）收治的 1 例运动相关性胸主动脉夹层患者的临床资料。结果患者为 43 岁男性，因“运动时突发胸背部疼痛 4 h”入我院，患者成功行胸主动脉腔内覆膜支架及左锁骨下动脉支架置入术，术后主动脉及左锁骨下动脉血流通畅，完整隔绝夹层病变，未发生内漏。手术时间 57 min，术中出血量 30 mL。术后 5 d 患者康复出院。出院后随访 6 个月，未发生头晕、胸痛、内漏、支架移位及闭塞。结论针对运动相关性胸主动脉夹层患者的临床特点，根据其发病诱因做出正确的诊断，采取合适的腔内成形术可以有效治疗。

Citation： 刘一人, 郭建明, 孟良, 徐泽勤, 佟铸, 谷涌泉, 郭连瑞. 运动诱发的胸主动脉夹层的诊治体会. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(4): 512-515. doi: 10.7507/1007-9424.202007125 Copy

1.	Erbel R, Aboyans V, Boileau C, et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J, 2014, 35(41): 2873-2926.
2.	Sheikh AS, Ali K, Mazhar S. Acute aortic syndrome. Circulation, 2013, 128(10): 1122-1127.
3.	Zhang K, Pan X, Zheng J, et al. Comparative tissue proteomics analysis of thoracic aortic dissection with hypertension using the iTRAQ technique. Eur J Cardiothorac Surg, 2015, 47(3): 431-438.
4.	华琦, 范振兴. 高血压与主动脉夹层. 岭南心血管病杂志, 2012, 18(1): 4-5, 68.
5.	Gawinecka J, Schönrath F, von Eckardstein A. Acute aortic dissection: pathogenesis, risk factors and diagnosis. Swiss Med Wkly, 2017, 147: w14489.
6.	Oparil S, Acelajado MC, Bakris GL, et al. Hypertension. Nat Rev Dis Primers, 2018, 4: 18014.
7.	Frattola A, Parati G, Cuspidi C, et al. Prognostic value of 24-hour blood pressure variability. J Hypertens, 1993, 11(10): 1133-1137.
8.	Blacher J, Safar ME, Ly C, et al. Blood pressure variability: cardiovascular risk integrator or independent risk factor? J Hum Hypertens, 2015, 29(2): 122-126.
9.	Li Y, Liu J, Wang W, et al. The association between within-visit blood pressure variability and carotid artery atherosclerosis in general population. PLoS One, 2014, 9(5): e97760.
10.	Liu Z, Zhao Y, Lu F, et al. Day-by-day variability in self-measured blood pressure at home: effects on carotid artery atherosclerosis, brachial flow-mediated dilation, and endothelin-1 in normotensive and mild-moderate hypertensive individuals. Blood Press Monit, 2013, 18(6): 316-325.
11.	Miao CY, Yuan WJ, Su DF. Comparative study of sinoaortic denervated rats and spontaneously hypertensive rats. Am J Hypertens, 2003, 16(7): 585-591.
12.	Wen Y, Leake DS. Low density lipoprotein undergoes oxidation within lysosomes in cells. Circ Res, 2007, 100(9): 1337-1343.
13.	Mestas J, Ley K. Monocyte-endothelial cell interactions in the development of atherosclerosis. Trends Cardiovasc Med, 2008, 18(6): 228-232.
14.	郑剑飞, 向旭东. 349例主动脉夹层患者的流行病学初步分析及MBD2在主动脉夹层中表达意义. 中南大学, 2013.
15.	del Porto F, Proietta M, Tritapepe L, et al. Inflammation and immune response in acute aortic dissection. Ann Med, 2010, 42(8): 622-629.
16.	He R, Guo DC, Estrera AL, et al. Characterization of the inflammatory and apoptotic cells in the aortas of patients with ascending thoracic aortic aneurysms and dissections. J Thorac Cardiovasc Surg, 2006, 131(3): 671-678.
17.	Ju X, Ijaz T, Sun H, et al. Interleukin-6-signal transducer and activator of transcription-3 signaling mediates aortic dissections induced by angiotensin Ⅱ via the T-helper lymphocyte 17-interleukin 17 axis in C57BL/6 mice. Arterioscler Thromb Vasc Biol, 2013, 33(7): 1612-1621.
18.	Zhang L, Liao MF, Tian L, et al. Overexpression of interleukin-1β and interferon-γ in type I thoracic aortic dissections and ascending thoracic aortic aneurysms: possible correlation with matrix metalloproteinase-9 expression and apoptosis of aortic media cells. Eur J Cardiothorac Surg, 2011, 40(1): 17-22.
19.	Nguyen KP, Mcgilvray KC, Puttlitz CM, et al. Matrix metalloproteinase 9 (MMP-9) regulates vein wall biomechanics in murine thrombus resolution. PLoS One, 2015, 10(9): e0139145.
20.	Singh KK, Rommel K, Mishra A, et al. TGFBR1 and TGFBR2 mutations in patients with features of Marfan syndrome and Loeys-Dietz syndrome. Hum Mutat, 2006, 27(8): 770-777.
21.	Smith LB, Hadoke PW, Dyer E, et al. Haploinsufficiency of the murine Col3a1 locus causes aortic dissection: a novel model of the vascular type of Ehlers-Danlos syndrome. Cardiovasc Res, 2011, 90(1): 182-190.
22.	Rhodes SD, Wu X, He Y, et al. Hyperactive transforming growth factor-β1 signaling potentiates skeletal defects in a neurofibromatosis type 1 mouse model. J Bone Miner Res, 2013, 28(12): 2476-2489.
23.	Mehta RH, Manfredini R, Bossone E, et al. Does circadian and seasonal variation in occurrence of acute aortic dissection influence in-hospital outcomes? Chronobiol Int, 2005, 22(2): 343-351.
24.	Rabus MB, Eren E, Erkanli K, et al. Does acute aortic dissection display seasonal variation? Heart Surg Forum, 2009, 12(4): E238-E240.
25.	Benouaich V, Soler P, Gourraud PA, et al. Impact of meteorological conditions on the occurrence of acute type A aortic dissections. Interact Cardiovasc Thorac Surg, 2010, 10(3): 403-406.
26.	DeAnda A, Grossi EA, Balsam LB, et al. The chronobiology of Stanford type A aortic dissections: A comparison of Northern versus Southern Hemispheres. Aorta (Stamford), 2015, 3(6): 182-186.
27.	范波, 孙卫东. 急性主动脉夹层时间分布规律. 华西医学, 2011, 26(4): 507-509.
28.	丘俊涛, 于存涛, 罗新锦, 等. 气候变化对主动脉夹层发生的影响. 中国胸心血管外科临床杂志, 2018, 25(6): 482-488.
29.	史敬, 马依彤. 乌鲁木齐急性主动脉夹层发病时间特点及气象相关性研究. 新疆医科大学, 2017.
30.	Pape LA, Awais M, Woznicki EM, et al. Presentation, diagnosis, and outcomes of acute aortic dissection: 17-year trends from the International Registry of Acute Aortic Dissection. J Am Coll Cardiol, 2015, 66(4): 350-358.
31.	周桂锋. 良性阵发性位置性眩晕的临床特点分析. 当代医学, 2016, 22(15): 40-41.
32.	熊彬彬, 赵晓明, 刘劲, 等. 良性阵发性位置性眩晕复位短期疗效不佳的分析. 中华耳科学杂志, 2016, 14(4): 473-477.
33.	马英, 卢延东, 张硕. X 线、CT、MRI对主动脉夹层的诊断价值及影像学比较. 临床和实验医学杂志, 2009, 8(1): 95-96.
34.	梁亦念, 欧桂娣. 浅谈主动脉夹层的CT影像诊断. 中外医疗, 2013, 32(15): 186, 188.
35.	布郎威著, 陈灏珠译. 心脏病学. 第5版, 北京: 人民卫生出版社, 1999: 408-1415.
36.	任伟, 王志维, 夏军, 等. Stanford B型夹层腔内修复术中左锁骨下动脉的处理. 实用医学杂志, 2014, 30(3): 450-452.
37.	Criado FJ, Barnatan MF, Rizk Y, et al. Technical strategies to expand stent-graft applicability in the aortic arch and proximal descending thoracic aorta. J Endovasc Ther, 2002, 9 Suppl 2: Ⅱ32-Ⅱ38.
38.	Ito H, Shimono T, Shimpo H, et al. Open surgery for abdominal aortic aneurysm in the era of endovascular repair: comparison with long term results of endovascular repair using Zenith stentgraft. Ann Vasc Dis, 2013, 6(2): 189-194.
39.	Moulakakis KG, Mylonas SN, Avgerinos E, et al. The chimney graft technique for preserving visceral vessels during endovascular treatment of aortic pathologies. J Vasc Surg, 2012, 55(5): 1497-1503.
40.	郑江华, 陈开, 朱彦斌, 等. 复杂Stanford B型主动脉夹层的腔内治疗策略. 中国普外基础与临床杂志, 2015, 22(8): 958-961.

1. Erbel R, Aboyans V, Boileau C, et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J, 2014, 35(41): 2873-2926.
2. Sheikh AS, Ali K, Mazhar S. Acute aortic syndrome. Circulation, 2013, 128(10): 1122-1127.
3. Zhang K, Pan X, Zheng J, et al. Comparative tissue proteomics analysis of thoracic aortic dissection with hypertension using the iTRAQ technique. Eur J Cardiothorac Surg, 2015, 47(3): 431-438.
4. 华琦, 范振兴. 高血压与主动脉夹层. 岭南心血管病杂志, 2012, 18(1): 4-5, 68.
5. Gawinecka J, Schönrath F, von Eckardstein A. Acute aortic dissection: pathogenesis, risk factors and diagnosis. Swiss Med Wkly, 2017, 147: w14489.
6. Oparil S, Acelajado MC, Bakris GL, et al. Hypertension. Nat Rev Dis Primers, 2018, 4: 18014.
7. Frattola A, Parati G, Cuspidi C, et al. Prognostic value of 24-hour blood pressure variability. J Hypertens, 1993, 11(10): 1133-1137.
8. Blacher J, Safar ME, Ly C, et al. Blood pressure variability: cardiovascular risk integrator or independent risk factor? J Hum Hypertens, 2015, 29(2): 122-126.
9. Li Y, Liu J, Wang W, et al. The association between within-visit blood pressure variability and carotid artery atherosclerosis in general population. PLoS One, 2014, 9(5): e97760.
10. Liu Z, Zhao Y, Lu F, et al. Day-by-day variability in self-measured blood pressure at home: effects on carotid artery atherosclerosis, brachial flow-mediated dilation, and endothelin-1 in normotensive and mild-moderate hypertensive individuals. Blood Press Monit, 2013, 18(6): 316-325.
11. Miao CY, Yuan WJ, Su DF. Comparative study of sinoaortic denervated rats and spontaneously hypertensive rats. Am J Hypertens, 2003, 16(7): 585-591.
12. Wen Y, Leake DS. Low density lipoprotein undergoes oxidation within lysosomes in cells. Circ Res, 2007, 100(9): 1337-1343.
13. Mestas J, Ley K. Monocyte-endothelial cell interactions in the development of atherosclerosis. Trends Cardiovasc Med, 2008, 18(6): 228-232.
14. 郑剑飞, 向旭东. 349例主动脉夹层患者的流行病学初步分析及MBD2在主动脉夹层中表达意义. 中南大学, 2013.
15. del Porto F, Proietta M, Tritapepe L, et al. Inflammation and immune response in acute aortic dissection. Ann Med, 2010, 42(8): 622-629.
16. He R, Guo DC, Estrera AL, et al. Characterization of the inflammatory and apoptotic cells in the aortas of patients with ascending thoracic aortic aneurysms and dissections. J Thorac Cardiovasc Surg, 2006, 131(3): 671-678.
17. Ju X, Ijaz T, Sun H, et al. Interleukin-6-signal transducer and activator of transcription-3 signaling mediates aortic dissections induced by angiotensin Ⅱ via the T-helper lymphocyte 17-interleukin 17 axis in C57BL/6 mice. Arterioscler Thromb Vasc Biol, 2013, 33(7): 1612-1621.
18. Zhang L, Liao MF, Tian L, et al. Overexpression of interleukin-1β and interferon-γ in type I thoracic aortic dissections and ascending thoracic aortic aneurysms: possible correlation with matrix metalloproteinase-9 expression and apoptosis of aortic media cells. Eur J Cardiothorac Surg, 2011, 40(1): 17-22.
19. Nguyen KP, Mcgilvray KC, Puttlitz CM, et al. Matrix metalloproteinase 9 (MMP-9) regulates vein wall biomechanics in murine thrombus resolution. PLoS One, 2015, 10(9): e0139145.
20. Singh KK, Rommel K, Mishra A, et al. TGFBR1 and TGFBR2 mutations in patients with features of Marfan syndrome and Loeys-Dietz syndrome. Hum Mutat, 2006, 27(8): 770-777.
21. Smith LB, Hadoke PW, Dyer E, et al. Haploinsufficiency of the murine Col3a1 locus causes aortic dissection: a novel model of the vascular type of Ehlers-Danlos syndrome. Cardiovasc Res, 2011, 90(1): 182-190.
22. Rhodes SD, Wu X, He Y, et al. Hyperactive transforming growth factor-β1 signaling potentiates skeletal defects in a neurofibromatosis type 1 mouse model. J Bone Miner Res, 2013, 28(12): 2476-2489.
23. Mehta RH, Manfredini R, Bossone E, et al. Does circadian and seasonal variation in occurrence of acute aortic dissection influence in-hospital outcomes? Chronobiol Int, 2005, 22(2): 343-351.
24. Rabus MB, Eren E, Erkanli K, et al. Does acute aortic dissection display seasonal variation? Heart Surg Forum, 2009, 12(4): E238-E240.
25. Benouaich V, Soler P, Gourraud PA, et al. Impact of meteorological conditions on the occurrence of acute type A aortic dissections. Interact Cardiovasc Thorac Surg, 2010, 10(3): 403-406.
26. DeAnda A, Grossi EA, Balsam LB, et al. The chronobiology of Stanford type A aortic dissections: A comparison of Northern versus Southern Hemispheres. Aorta (Stamford), 2015, 3(6): 182-186.
27. 范波, 孙卫东. 急性主动脉夹层时间分布规律. 华西医学, 2011, 26(4): 507-509.
28. 丘俊涛, 于存涛, 罗新锦, 等. 气候变化对主动脉夹层发生的影响. 中国胸心血管外科临床杂志, 2018, 25(6): 482-488.
29. 史敬, 马依彤. 乌鲁木齐急性主动脉夹层发病时间特点及气象相关性研究. 新疆医科大学, 2017.
30. Pape LA, Awais M, Woznicki EM, et al. Presentation, diagnosis, and outcomes of acute aortic dissection: 17-year trends from the International Registry of Acute Aortic Dissection. J Am Coll Cardiol, 2015, 66(4): 350-358.
31. 周桂锋. 良性阵发性位置性眩晕的临床特点分析. 当代医学, 2016, 22(15): 40-41.
32. 熊彬彬, 赵晓明, 刘劲, 等. 良性阵发性位置性眩晕复位短期疗效不佳的分析. 中华耳科学杂志, 2016, 14(4): 473-477.
33. 马英, 卢延东, 张硕. X 线、CT、MRI对主动脉夹层的诊断价值及影像学比较. 临床和实验医学杂志, 2009, 8(1): 95-96.
34. 梁亦念, 欧桂娣. 浅谈主动脉夹层的CT影像诊断. 中外医疗, 2013, 32(15): 186, 188.
35. 布郎威著, 陈灏珠译. 心脏病学. 第5版, 北京: 人民卫生出版社, 1999: 408-1415.
36. 任伟, 王志维, 夏军, 等. Stanford B型夹层腔内修复术中左锁骨下动脉的处理. 实用医学杂志, 2014, 30(3): 450-452.
37. Criado FJ, Barnatan MF, Rizk Y, et al. Technical strategies to expand stent-graft applicability in the aortic arch and proximal descending thoracic aorta. J Endovasc Ther, 2002, 9 Suppl 2: Ⅱ32-Ⅱ38.
38. Ito H, Shimono T, Shimpo H, et al. Open surgery for abdominal aortic aneurysm in the era of endovascular repair: comparison with long term results of endovascular repair using Zenith stentgraft. Ann Vasc Dis, 2013, 6(2): 189-194.
39. Moulakakis KG, Mylonas SN, Avgerinos E, et al. The chimney graft technique for preserving visceral vessels during endovascular treatment of aortic pathologies. J Vasc Surg, 2012, 55(5): 1497-1503.
40. 郑江华, 陈开, 朱彦斌, 等. 复杂Stanford B型主动脉夹层的腔内治疗策略. 中国普外基础与临床杂志, 2015, 22(8): 958-961.

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运动诱发的胸主动脉夹层的诊治体会

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