Gawinecka Joanna, Schönrath Felix, von Eckardstein Arnold
Institute of the Clinical Chemistry, University Hospital Zurich, Switzerland.
Department of Cardiac, Thoracic and Vascular Surgery, German Heart Institute, Berlin, Germany.
Swiss Med Wkly. 2017 Aug 25;147:w14489. doi: 10.4414/smw.2017.14489. eCollection 2017.
Acute aortic dissection is a rare but life-threatening condition with a lethality rate of 1 to 2% per hour after onset of symptoms in untreated patients. Therefore, its prompt and proper diagnosis is vital to increase a patient's chance of survival and to prevent grievous complications. Typical symptoms of acute aortic dissection include severe chest pain, hypotension or syncope and, hence, mimic acute myocardial infarction or pulmonary embolism. Advanced age, male gender, long-term history of arterial hypertension and the presence of aortic aneurysm confer the greatest population attributable risk. However, patients with genetic connective tissue disorders such as Marfan, Loeys Dietz or Ehlers Danlos syndrome, and patients with bicuspid aortic valves are at the increased risk of aortic dissection at a much younger age. Imaging provides a robust foundation for diagnosing acute aortic dissection, as well as for monitoring of patients at increased risk of aortic disease. As yet, easily accessible blood tests play only a small role but have the potential to make diagnosis and monitoring of patients simpler and more cost-effective.
急性主动脉夹层是一种罕见但危及生命的疾病，未经治疗的患者在症状出现后每小时的致死率为1%至2%。因此，及时、正确的诊断对于提高患者的生存几率和预防严重并发症至关重要。急性主动脉夹层的典型症状包括严重胸痛、低血压或晕厥，因此酷似急性心肌梗死或肺栓塞。高龄、男性、长期动脉高血压病史以及主动脉瘤的存在是最大的人群归因风险因素。然而，患有马凡综合征、洛伊迪茨综合征或埃勒斯-丹洛斯综合征等遗传性结缔组织疾病的患者，以及患有二叶式主动脉瓣的患者，在年龄小得多的时候发生主动脉夹层的风险就会增加。影像学为诊断急性主动脉夹层以及监测主动脉疾病风险增加的患者提供了有力依据。迄今为止，易于获取的血液检测仅起很小的作用，但有可能使患者的诊断和监测更简单、更具成本效益。
