The Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.
Nat Rev Cardiol. 2011 Feb;8(2):103-13. doi: 10.1038/nrcardio.2010.187. Epub 2010 Dec 21.
Thoracic aortic dissection (TAD) is estimated to occur at a rate of 3-4 cases per 100,000 persons per year and is associated with a high mortality. Reported rates are probably underestimates of the true incidence of TAD because of difficulties in diagnosis. The incidence of TAD appears to have been increasing over time. TAD is most common in men and older individuals. Aortic dilatation is a well-established risk factor for TAD but is not a prerequisite; most ascending aortic dissections occur when aortic diameter is <5.5 cm. Although atherosclerosis and typical cardiovascular risk factors, such as hypertension and smoking, are associated with TAD, evidence supporting their direct causal role is lacking. Notably, diabetes mellitus is remarkably uncommon in patients with TAD. Other risk factors for TAD include inflammatory diseases, iatrogenic aortic injury, and drug use. Congenital cardiovascular defects, such as bicuspid aortic valve, and certain genetic syndromes, such as Marfan syndrome, are the genetic factors most commonly associated with TAD. Specific nonsyndromic genetic mutations in families and single nucleotide polymorphisms have also been identified as possible risk factors for TAD.
胸主动脉夹层（TAD）估计每年每 10 万人中发生 3-4 例，死亡率较高。由于诊断困难，报告的发生率可能低估了 TAD 的真实发病率。TAD 的发病率似乎随着时间的推移而增加。TAD 最常见于男性和老年人。主动脉扩张是 TAD 的一个既定危险因素，但不是先决条件；大多数升主动脉夹层发生在主动脉直径<5.5cm 时。尽管动脉粥样硬化和典型的心血管危险因素，如高血压和吸烟，与 TAD 相关，但缺乏直接因果关系的确凿证据。值得注意的是，TAD 患者中糖尿病非常罕见。TAD 的其他危险因素包括炎症性疾病、医源性主动脉损伤和药物使用。先天性心血管缺陷，如二叶主动脉瓣，以及某些遗传综合征，如马凡综合征，是与 TAD 最常相关的遗传因素。在家族中还确定了特定的非综合征遗传突变和单核苷酸多态性作为 TAD 的可能危险因素。
