Akutsu Koichi
Division of Vascular Medicine, Department of Cardiovascular Surgery, Kawasaki Aortic Center, Kawasaki Saiwai Hospital, 31-21, Ohmiya-cho, Saiwaiku, Kawasaki, Kanagawa, 212-0014, Japan.
Gen Thorac Cardiovasc Surg. 2019 Mar;67(3):271-276. doi: 10.1007/s11748-019-01066-x. Epub 2019 Jan 28.
We discuss the etiology of aortic dissection (AD) from various points of view. The development of AD requires two pathological conditions: medial degeneration and mechanical wall stress. First, histopathological findings of medial degeneration are hypothesized to be due to a loss of elastic fibers and interconnecting elastic fibers. Damage to the vasa vasorum plays a key role in creating an entry site. The clinical causes of medial degeneration include hypertension, aortic aneurysms, obstructive sleep apnea, and connective tissue disorders. Second, mechanical wall stress is supposedly induced by shear stress caused by blood flow, together with hypertension and aortic root movement. Further investigation is necessary in the search for mechanisms responsible for medial degeneration prior to AD development.
我们从不同角度探讨主动脉夹层（AD）的病因。AD的发生需要两个病理条件：中膜退变和机械性壁应力。首先，中膜退变的组织病理学表现被认为是由于弹性纤维和相互连接的弹性纤维缺失所致。滋养血管受损在形成入口部位起关键作用。中膜退变的临床病因包括高血压、主动脉瘤、阻塞性睡眠呼吸暂停和结缔组织疾病。其次，机械性壁应力据推测是由血流引起的剪切应力，以及高血压和主动脉根部运动共同诱发的。在寻找AD发生前中膜退变的机制方面，还需要进一步研究。
