運動誘發的胸主動脈夾層的診治體會_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

劉一人 , 郭建明 , 孟良 , 徐澤勤 , 佟鑄 , 谷涌泉 ,  郭連瑞

首都醫科大學宣武醫院血管外科（北京 100053）;

Corresponding?author：

郭連瑞, Email: 1044832160@qq.com

Keywords：

胸主動脈夾層; 腔內治療; 支架置入; 運動

DOI：

10.7507/1007-9424.202007125

Video：

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目的總結運動相關性胸主動脈夾層的臨床和影像學特點以及腔內治療的可行性。方法回顧性分析首都醫科大學宣武醫院（簡稱“我院”）收治的 1 例運動相關性胸主動脈夾層患者的臨床資料。結果患者為 43 歲男性，因“運動時突發胸背部疼痛 4 h”入我院，患者成功行胸主動脈腔內覆膜支架及左鎖骨下動脈支架置入術，術后主動脈及左鎖骨下動脈血流通暢，完整隔絕夾層病變，未發生內漏。手術時間 57 min，術中出血量 30 mL。術后 5 d 患者康復出院。出院后隨訪 6 個月，未發生頭暈、胸痛、內漏、支架移位及閉塞。結論針對運動相關性胸主動脈夾層患者的臨床特點，根據其發病誘因做出正確的診斷，采取合適的腔內成形術可以有效治療。

Citation： 劉一人, 郭建明, 孟良, 徐澤勤, 佟鑄, 谷涌泉, 郭連瑞. 運動誘發的胸主動脈夾層的診治體會. 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.	華琦, 范振興. 高血壓與主動脈夾層. 嶺南心血管病雜志, 2012, 18(1): 4-5, 68.
5.	Gawinecka J, Sch?nrath 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.	鄭劍飛, 向旭東. 349例主動脈夾層患者的流行病學初步分析及MBD2在主動脈夾層中表達意義. 中南大學, 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, 孫衛東. 急性主動脈夾層時間分布規律. 華西醫學, 2011, 26(4): 507-509.
28.	丘俊濤, 于存濤, 羅新錦, 等. 氣候變化對主動脈夾層發生的影響. 中國胸心血管外科臨床雜志, 2018, 25(6): 482-488.
29.	史敬, 馬依彤. 烏魯木齊急性主動脈夾層發病時間特點及氣象相關性研究. 新疆醫科大學, 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.	周桂鋒. 良性陣發性位置性眩暈的臨床特點分析. 當代醫學, 2016, 22(15): 40-41.
32.	熊彬彬, 趙曉明, 劉勁, 等. 良性陣發性位置性眩暈復位短期療效不佳的分析. 中華耳科學雜志, 2016, 14(4): 473-477.
33.	馬英, 盧延東, 張碩. X 線、CT、MRI對主動脈夾層的診斷價值及影像學比較. 臨床和實驗醫學雜志, 2009, 8(1): 95-96.
34.	梁亦念, 歐桂娣. 淺談主動脈夾層的CT影像診斷. 中外醫療, 2013, 32(15): 186, 188.
35.	布郎威著, 陳灝珠譯. 心臟病學. 第5版, 北京: 人民衛生出版社, 1999: 408-1415.
36.	任偉, 王志維, 夏軍, 等. Stanford B型夾層腔內修復術中左鎖骨下動脈的處理. 實用醫學雜志, 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.	鄭江華, 陳開, 朱彥斌, 等. 復雜Stanford B型主動脈夾層的腔內治療策略. 中國普外基礎與臨床雜志, 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. 華琦, 范振興. 高血壓與主動脈夾層. 嶺南心血管病雜志, 2012, 18(1): 4-5, 68.
5. Gawinecka J, Sch?nrath 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. 鄭劍飛, 向旭東. 349例主動脈夾層患者的流行病學初步分析及MBD2在主動脈夾層中表達意義. 中南大學, 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, 孫衛東. 急性主動脈夾層時間分布規律. 華西醫學, 2011, 26(4): 507-509.
28. 丘俊濤, 于存濤, 羅新錦, 等. 氣候變化對主動脈夾層發生的影響. 中國胸心血管外科臨床雜志, 2018, 25(6): 482-488.
29. 史敬, 馬依彤. 烏魯木齊急性主動脈夾層發病時間特點及氣象相關性研究. 新疆醫科大學, 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. 周桂鋒. 良性陣發性位置性眩暈的臨床特點分析. 當代醫學, 2016, 22(15): 40-41.
32. 熊彬彬, 趙曉明, 劉勁, 等. 良性陣發性位置性眩暈復位短期療效不佳的分析. 中華耳科學雜志, 2016, 14(4): 473-477.
33. 馬英, 盧延東, 張碩. X 線、CT、MRI對主動脈夾層的診斷價值及影像學比較. 臨床和實驗醫學雜志, 2009, 8(1): 95-96.
34. 梁亦念, 歐桂娣. 淺談主動脈夾層的CT影像診斷. 中外醫療, 2013, 32(15): 186, 188.
35. 布郎威著, 陳灝珠譯. 心臟病學. 第5版, 北京: 人民衛生出版社, 1999: 408-1415.
36. 任偉, 王志維, 夏軍, 等. Stanford B型夾層腔內修復術中左鎖骨下動脈的處理. 實用醫學雜志, 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. 鄭江華, 陳開, 朱彥斌, 等. 復雜Stanford B型主動脈夾層的腔內治療策略. 中國普外基礎與臨床雜志, 2015, 22(8): 958-961.

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運動誘發的胸主動脈夾層的診治體會

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