Makita Shinji, Ohira Atsushi, Naganuma Yujiro, Moriai Yoshiteru, Niinuma Hiroyuki, Abiko Akihiko, Hiramori Katsuhiko
Department of Medicine II, Iwate Medical University, Morioka, Japan.
Angiology. 2006 Aug-Sep;57(4):478-86. doi: 10.1177/0003319706290625.
The arterial properties and pathogenesis of aortic dissection remain obscure. To examine the arterial properties of patients with aortic dissection, the authors studied the ultrasonographic characteristics of the carotid artery in patients with an aortic dissection (AD, n = 86), and compared these findings with data of patients suffering from arteriosclerosis obliterans (ASO, n = 151), coronary artery disease (CAD, n = 163), and with healthy controls (HC, n = 77). Atherosclerotic intimal changes, such as intima-media thickness (IMT) and plaque formation, were milder in AD than in ASO or CAD (IMT: 0.83 +/- 0.16 vs 0.93 +/- 0.20/0.86 +/- 0.17 mm, p < 0.05; plaque number: 0.6 +/- 1.1 vs 2.7 +/- 2.4/2.5 +/- 2.1, p <0.05). Luminal diameter in AD, ASO, and CAD was significantly higher than in HC. The luminal distensibility in AD was decreased compared with HC but was the same as in ASO and CAD. Intra-AD group analysis showed that in patients with an intramural hematoma (IMH) or a dissection with a thrombosed false lumen (TLF) the IMT was higher than in patients with a classic dissection. In addition, plaque formation was more severe in AD patients with a coexisting abdominal aortic aneurysm (AAA). Reduced distensibility without severe intimal disease was found in AD. These findings suggest that patients with AD may have several arterial alterations, including structural abnormalities. Patients with IMH, TFL, or coexisting AAA may differ from patients who have a classic type of dissection or who do not have AAA, in terms of arterial characteristics including intimal disease and wall elastic property, and the initiating cause of the dissection.
主动脉夹层的动脉特性及发病机制仍不清楚。为研究主动脉夹层患者的动脉特性，作者对86例主动脉夹层（AD）患者的颈动脉超声特征进行了研究，并将这些结果与151例闭塞性动脉硬化（ASO）患者、163例冠状动脉疾病（CAD）患者以及77例健康对照者（HC）的数据进行了比较。AD患者的动脉粥样硬化内膜改变，如内膜中层厚度（IMT）和斑块形成，比ASO或CAD患者轻（IMT：0.83±0.16 vs 0.93±0.20/0.86±0.17mm，p<0.05；斑块数量：0.6±1.1 vs 2.7±2.4/2.5±2.1，p<0.05）。AD、ASO和CAD患者的管腔直径显著高于HC患者。与HC相比，AD患者的管腔扩张性降低，但与ASO和CAD患者相同。AD组内分析显示，壁内血肿（IMH）或伴有血栓形成假腔（TLF）的夹层患者的IMT高于典型夹层患者。此外，合并腹主动脉瘤（AAA）的AD患者斑块形成更严重。AD患者存在扩张性降低但无严重内膜疾病的情况。这些发现表明，AD患者可能有多种动脉改变，包括结构异常。在包括内膜疾病和壁弹性特性在内的动脉特征以及夹层的起始原因方面，IMH、TFL或合并AAA的患者可能与典型夹层患者或无AAA的患者不同。
