陶莉莉 李芳 毛鹭 段永春 廖睿 许钰唯 陈安宝

[摘要] 急性主动脉夹层（AAD）是一种临床较少见的大血管病变，以剧烈“撕裂样”或“刀割样”持续性难以忍受的锐痛为典型的症状，主要病变基础是中膜弹力纤维和平滑肌损伤或发育缺陷，还与动脉粥样硬化、高血压、主动脉缩窄和医源性损伤等因素的关系密切，且其死亡率较高。近年来，随着生活水平和饮食习惯的转变，该病的发病率逐渐上升，引起了临床医师的高度重视。而早期快速准确诊断对降低AAD患者的病死率、误诊率以及预后具有重要意义。AAD的确诊方法目前主要包括主动脉CT血管造影检查、核磁共振成像、超声心动图，其中主动脉CT血管造影检查是诊断AAD的首选检查。该文就目前AAD的最新早期诊断和预后评估的相关的研究现状和发展方向进行综述，以供临床参考。

[关键词] 主动脉夹层;生物标志物;影像学;诊断

[中图分类号] R543.1          [文献标识码] A          [文章编号] 1674-0742（2020）06（c）-0196-03

New Advances in Early Diagnosis of Acute Aortic Dissection

TAO Li-li， LI Fang， MAO Lu， DUAN Yong-chun， LIAO Rui， XU Yu-wei， CHEN An-bao

Department of Emergency Medicine， Second Affiliated Hospital of Kunming Medical University， Kunming， Yunnan Province 650000 China

[Abstract] Acute aortic dissection （AAD） is a clinically rare large vascular disease， which is characterized by severe "tear-like" or "knife-like" persistent and unbearable sharp pain. Membrane elastic fiber and smooth muscle injury or developmental defects are also closely related to factors such as atherosclerosis， hypertension， aortic constriction， and iatrogenic injury， and their mortality rates are high. In recent years， with the change of living standards and eating habits， the incidence of the disease has gradually increased， which has attracted great attention from clinicians. Early and accurate diagnosis is of great significance to reduce the mortality， misdiagnosis rate and prognosis of AAD patients. The diagnosis methods of AAD currently mainly include aortic CT angiography， magnetic resonance imaging， and echocardiography. Among them， aortic CT angiography is the first choice for the diagnosis of AAD. This article reviews the current research status and development direction of the latest early diagnosis and prognosis assessment of AAD， for clinical reference.

[Key words] Aortic dissection; Biomarkers; Imaging; Diagnosis

主動脉夹层（AAD）是主动脉的血流在高速高压的状态下从动脉内膜撕裂处进入中层或中层主动脉壁，并沿着主动脉纵轴不断扩张形成血肿，分离主动脉中膜和外膜，部分患者的外膜继续扩张膨出会形成动脉瘤，发病率为6/100 000，发病率呈逐年上升趋势，发病年龄也较为年轻化。根据发病时间的长短可将主动脉夹层分为急性主动脉夹层（发病时间≤14 d）和慢性主动脉夹层（发病时间>14 d），临床多在内科药物治疗基础上行外科手术和腔内修复术进行治疗，以改善患者的预后。但……