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Physical and Emotional Stress May Trigger Aortic Dissection
嚴重的身體和情緒應激會促發主動脈夾層形成
Severe physical and emotional stress may represent inciting events for acute aortic dissection, new research suggests. The mechanism is likely to involve a sharp rise in blood pressure, which causes the tear.
最新的研究顯示，嚴重的身體和情緒應激可能代表急性主動脈壁夾層形成的激發事件。引起主動脈壁撕裂的發病機制很可能包括血壓的急劇升高。
Hypertension, aortic dilatation, and collagen disorders have all been linked to acute aortic dissection, but the inciting events, immediately preceding the tear, were unclear, according to the report in the American Journal of Cardiology for November.
高血壓、主動脈擴張、膠原代射障礙都已與急性主動脈壁夾層形成密切相關，但是，據11月份的美國心臟病雜志報道稱，人們對于主動脈壁撕裂的即刻前驅激發事件還不了解。
Dr. John A. Elefteriades and colleagues, from Yale University School of Medicine investigated physical and emotional stress as inciting events by analyzing data from 175 consecutive patients with aortic dissection who were treated at their center over a 10-year period. In addition to performing a chart review, the researchers were able to conduct telephone interviews for 90 of the patients.
來自耶魯大學醫學院的John A Elefteriades博士與其同事，通過分析10年間在他們中心治療的連續175個主動脈壁夾層形成患者的資料，研究了作為刺激性事件的身體和情緒應激。除了進行列表回顧分析，研究者們還對其中的90名患者進行電話采訪。
Sixty-five of the patients were women and the average age was 61 years, the report indicates. The ascending aorta was involved in 110 cases and the descending aorta in 65.
該報道指出，其中65名患者是女性，患者的平均年齡為61歲。110例升主動脈受累，65例降主動脈受累。
Of the 90 patients contacted by telephone, 65 could recall a specific inciting event, the researchers note. The ascending aorta was involved in 34 of these patients and the descending aorta in 31. Eighteen of the patients had a family history of aortic disease.
研究者指出，其中90名電話隨訪的患者中，有65名患者能夠回憶起特定的激發事件。這些患者中，有34名患者升主動脈受累，31名患者降主動脈受累。患者中有18名有主動脈疾病的家族史。
Strenuous activity was identified as a precipitating factor for aortic dissection in 24 of the 90 patients (27%) contacted. Severe emotional stress was identified as an inciting event in 36 cases (40%).
電話隨訪的90名患者中的24名(27%)認定重體力作業為主動脈壁夾層形成的促發因素。36例(40%)患者將嚴重的情緒應激認定為激發事件。
"Thus, 2/3 of patients were able to identify either severe exertion or severe emotion as a trigger for their acute aortic dissection," Dr. Elefteriades and colleagues note.
Elefteriades 博士及其同事指出，“因此，2/3的患者能夠明確其患急性主動脈壁夾層形成的觸發因素是嚴重的勞累應激還是過度的情緒應激”。
Three of the dissections were iatrogenic, the report indicates, and in two other patients a COPD flare-up, with heavy coughing, preceded the acute onset of chest pain.
該報道指出，這些主動脈壁夾層形成的病例中有3例是醫源性的，另外有2名患者在急性胸痛發作之前存在COPD突然加重，伴有劇烈咳嗽。
The authors hypothesize that an individual's genetic background determines the initial susceptibility to aortic dissection. Over time, matrix metalloproteinases and other enzymes slowly degrade the aortic walls, possibly leading to aortic dilation. These factors set the stage for an acute physical or emotional stressor to trigger the dissection itself.
作者猜測可能是個體的遺傳背景決定了主動脈壁夾層形成的最初易感性。隨著時間的推移，金屬蛋白酶以及其他的酶類慢慢地降解動脈壁，并可能導致動脈擴張。這些因素使得急性身體和精神應激因素有用武之地，并最終導致主動脈夾層。
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