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医学英语talk show节目第十四期 2007-11-25 17:16:58 | Physical and Emotional Stress May Trigger Aortic Dissection
严重的身体和情绪应激会促发主动脉夹层形成
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.
最新的研究显示，严重的身体和情绪应激可能代表急性主动脉壁夹层形成的激发事件。引起主动脉壁撕裂的发病机制很可能包括血压的急剧升高。
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.
高血压、主动脉扩张、胶原代射障碍都已与急性主动脉壁夹层形成密切相关，但是，据11月份的美国心脏病杂志报道称，人们对于主动脉壁撕裂的即刻前驱激发事件还不了解。
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.
来自耶鲁大学医学院的John A Elefteriades博士与其同事，通过分析10年间在他们中心治疗的连续175个主动脉壁夹层形成患者的资料，研究了作为刺激性事件的身体和情绪应激。除了进行列表回顾分析，研究者们还对其中的90名患者进行电话采访。
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.
该报道指出，其中65名患者是女性，患者的平均年龄为61岁。110例升主动脉受累，65例降主动脉受累。
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名电话随访的患者中，有65名患者能够回忆起特定的激发事件。这些患者中，有34名患者升主动脉受累，31名患者降主动脉受累。患者中有18名有主动脉疾病的家族史。
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%).
电话随访的90名患者中的24名(27%)认定重体力作业为主动脉壁夹层形成的促发因素。36例(40%)患者将严重的情绪应激认定为激发事件。
"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的患者能够明确其患急性主动脉壁夹层形成的触发因素是严重的劳累应激还是过度的情绪应激”。
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.
该报道指出，这些主动脉壁夹层形成的病例中有3例是医源性的，另外有2名患者在急性胸痛发作之前存在COPD突然加重，伴有剧烈咳嗽。
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.
作者猜测可能是个体的遗传背景决定了主动脉壁夹层形成的最初易感性。随着时间的推移，金属蛋白酶以及其他的酶类慢慢地降解动脉壁，并可能导致动脉扩张。这些因素使得急性身体和精神应激因素有用武之地，并最终导致主动脉夹层。
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