【摘要】 颈部动脉壁内血肿(Ce AD)的发病率较低,是青、中年人群缺血性脑卒中的主要病因之一,近期Ce AD的大型临床研究在发病机制及危险因素方面提出了一些新的观点。对Ce AD患者的颞动脉中膜-外膜交界区的病理学观察发现受累动脉的动脉壁较薄弱,多中心的大型研究发现与年龄相当的健康人群及其它病因所致的缺血性脑卒中患者相比,高血压病、偏头痛尤其是无先兆性偏头痛,被认为是Ce AD的危险因素;颈部外伤及近期感染也是Ce AD的危险因素;高同型半胱氨酸血症、超重也与Ce AD密切相关。危险因素的多样性及颈动脉与椎动脉的不同结构特征均提示颈部动脉壁内血肿有不同的病理生理学发病机制,肌纤维发育不良与可逆性脑血管收缩综合征的发生相关。虽然大型队列研究提高了我们对Ce AD病理生理方面的认识,但其分子发生机制仍知之甚少,未来的基因工程研究有助于在分子水平上阐明Ce AD的发病机制。更多还原

【Abstract】 Cervical artery dissection( Ce AD) is a major cause of ischemic stroke in young and middle-aged adults,although relatively uncommon in the community. Recent large collaborative projects have provided new insights into mechanisms and risk factors of Ce AD. Pathologic changes observed at the media-adventitia border in temporal arteries of Ce AD patients suggest a predisposing arterial wall weakness. In large multicenter series of Ce AD patients,compared with agematched healthy controls and patients with an ischemic stroke of another cause,hypertension and migraine,especially without aura,were confirmed as risk factors for Ce AD,in addition to cervical trauma and recent infection. Hypercholesterolemia and being overweight were shown to be inversely associated with Ce AD. Differences in risk factor profile and structural features between carotid and vertebral dissection suggest that their pathophysiology may partly differ. An association of Ce AD with fibromuscular dysplasia and reversible cerebral vasoconstriction syndrome was described. Genetic risk factors of Ce AD are still poorly understood. Large cohorts of Ce AD patients have refined our understanding of the pathophysiology and risk factors of Ce AD,but the molecular mechanisms are still poorly understood. Ongoing high-throughput genetic projects will hopefully provide novel insight into the biological substrate of Ce AD.更多还原