内侧新生血管：高血压人群主动脉夹层的新机制？
Medial Neovascularization: A Novel Mechanism of Aortic Dissection in a Hypertensive Population?
摘要(中文译文)
本研究旨在阐明滋养血管对高血压患者主动脉夹层自然进展的影响。采用病理学观察和剪切应力测量方法，对43例参与者（中位年龄53岁；女性占32.6%）的全层升主动脉壁进行分析。采用Kruskal-Wallis检验和重复测量方差分析，对高血压夹层组（AD，n=23）、高血压对照组（n=12）和非高血压夹层组（non-HT-AD，n=8）进行比较。与对照组相比，AD组主动脉中膜外三分之一层内观察到更高密度的滋养血管（中膜新生血管化[medial neovascularization，MN]）（校正P=0.02）。在AD组中，MN常与中膜撕裂部位相吻合，且MN分级高于其他两组（总体P=0.01；non-HT-AD组与AD组比较：校正P=0.05；对照组与AD组比较：校正P=0.05）。各组均可见中膜退行性变。与non-HT-AD组相比，AD组的中膜退行性变分级反而更低（校正P=0.006）。AD组MN区域内可见弹性纤维和胶原纤维的多中心断裂。生物力学测试显示，与对照组相比，AD组在相似区域内的跨层拉伸范围差异显著增大（交互作用P<0.001；P<0.001）。中膜外层MN及其继发的滋养血管破裂可能代表高血压相关主动脉夹层的一种替代性起始事件，有别于经典的内膜撕裂。然而，本研究的横断面性质限制了确定性因果结论的得出。
Abstract
This study aimed to elucidate the impact of vasa vasorum on the natural progression of aortic dissection in patients with hypertension. Full-thickness ascending aortic walls from 43 participants (median age, 53 years; 32.6% women) were analyzed using pathological observation and shear stress measurement. Comparisons among hypertensive dissection (AD, n=23), hypertensive control (n=12), and nonhypertensive dissection (non-HT-AD, n=8) groups were performed using Kruskal-Wallis and repeated-measures ANOVA tests. Compared with the control group, a higher density of vasa vasorum was observed within the outer third of the tunica media (medial neovascularization [MN]) in the AD group (adjusted =0.02). In the AD group, MN frequently coincided with the site of medial tearing, and the MN grade was higher than in the other 2 groups (overall: =0.01; non-HT-AD versus AD group: adjusted =0.05; control versus AD group: adjusted =0.05). Medial degeneration was observed in all of the groups. Compared with the non-HT-AD group, the medial degeneration grade was even lower in the AD group (adjusted =0.006). Multicenter fractures of elastic and collagen fibers were evident within the MN region in the AD group. Biomechanical testing revealed a significantly increasing translamellar discrepancy in stretch ranges inside the similar region (<0.001 for interaction; <0.001) in the AD group when compared with the control group. MN and subsequent vasa vasorum rupture in the outer tunica media may represent an alternative initiating event in hypertension-related aortic dissection, distinct from the classical intimal tear. However, the cross-sectional nature of this study precludes definitive causal conclusions.
如何引用
AMA
Yong Lin, Xiao-Chai Lv, Zi-Wen Cai, Yue Shen, Mei-Fang Chen, Lin-Feng Xie, et al. Medial Neovascularization: A Novel Mechanism of Aortic Dissection in a Hypertensive Population?. Journal of the American Heart Association. 2026; doi:10.1161/JAHA.125.047349.
APA
Yong Lin, Xiao-Chai Lv, Zi-Wen Cai, Yue Shen, Mei-Fang Chen, Lin-Feng Xie, et al (2026). Medial Neovascularization: A Novel Mechanism of Aortic Dissection in a Hypertensive Population?. Journal of the American Heart Association. https://doi.org/10.1161/JAHA.125.047349
GB/T 7714
Yong Lin, Xiao-Chai Lv, Zi-Wen Cai, Yue Shen, Mei-Fang Chen, Lin-Feng Xie, et al. Medial Neovascularization: A Novel Mechanism of Aortic Dissection in a Hypertensive Population?[J]. Journal of the American Heart Association, 2026 doi:10.1161/JAHA.125.047349.
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