【好予医学英语第4期】临床篇之心血管病学（二）

发布时间：2021/11/10 11:34:58

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本期为循环系统疾病的第二讲，主要讨论动脉瘤和动脉粥样硬化这两个较为常见的心血管系统疾病。

动脉瘤是由于动脉壁的病变或损伤，形成动脉壁局限性或弥漫性扩张或膨出的表现，以膨胀性、搏动性肿块为主要表现，可以发生在动脉系统的任何部位，而以肢体主干动脉、主动脉和颈动脉较为常见。

动脉粥样硬化是冠心病、脑梗死、外周血管病的主要原因。脂质代谢障碍为动脉粥样硬化的病变基础，其特点是受累动脉病变从内膜开始，先有脂质和复合糖类积聚、出血及血栓形成，进而纤维组织增生及钙质沉着，并有动脉中层的逐渐蜕变和钙化，导致动脉壁增厚变硬、血管腔狭窄。由于在动脉内膜积聚的脂质外观呈黄色粥样，因此称为动脉粥样硬化。

案例分析

Case 1：A 75-year-old man visit his physician complaining of lower back pain. He has a history of hyperlipidemia and hypertension. On physical examination, he is obese and has moderately limited range of motion of the back. MRI shows that the abdominal aorta is dilated to 4 cm, 200% its normal size.

案例1：75岁男性主诉腰背部疼痛。患者有高脂血症和高血压病史，体检显示肥胖、背部活动中等程度受限。MRI显示腹主动脉扩张，直径达4 cm，较正常扩大2倍。

1. What is the most likely diagnosis?

Abdominal aortic aneurysm (AAA).

腹主动脉瘤

疾病特点：有多种血管病变危险因素+腰背部疼痛，扩冠抗凝治疗无效，CT/MRI可明确诊断。

2. What is the three-layer composition of muscular arteries?

The tunica intima is adjacent to the lumen and includes the endothelial layer and the internal elastic lamina.

The tunica media includes smooth muscle, collagen, and reticular and elastic fibers.

The tunica adventitia contains blood and lymph vessels and nerves supplying the artery.

动脉壁构造：内膜→内皮细胞层+弹性内膜；中膜→平滑肌+胶原；外膜→血管+淋巴管

3. An increased risk of AAA is associated with defects in the genes coding for which proteins?

Fibrillin and collagen. Marfan syndrome is linked to a mutation in the fibrillin-1 gene. Ehlers-Danlos syndrome results from various defects in collagen synthesis or structure. Both syndromes are associated with an increased incidence of AAA.

腹主动脉瘤（AAA）相关基因突变：原纤蛋白-1突变→马凡综合征，身材手指颀长，多有运动天赋（如前美国女排运动员海曼死于此病）；胶原合成缺陷→Ehlers-Danlos综合征又称先天性结缔组织发育不全综合征，指有皮肤和血管脆弱，皮肤弹性过强关节活动过大3大主症的一组遗传性疾病。

4. What are the risk factors for this condition?

AAA occurs most frequently in males. Advanced age and smoking are the most common risk factors. Atherosclerotic lesions in the abdominal aorta are thought to increase the risk of AAA; Other risk factors for aneurysmal disease of the aorta include aortic infection, trauma, vasculitis, and connective tissue disorders such as cystic medial necrosis as seen in Ehlers-Danlos syndrome or Marfan syndrome.

AAA危险因素：最主要→男性、老年、吸烟；次要→粥样斑块（高血压主要引起主动脉夹层，注意鉴别）

5. What are the treatment options for this condition?

A small, symptomatic AAA can be treated conservatively with frequent ultrasound surveillance and smoking cessation. Rapidly expanding aneurysms or those>5.5 cm in diameter require surgical repair.

治疗: 较小或无症状→保守治疗+随访+戒烟；迅速扩大或直径>5.5cm→手术治疗

Case 2: A 58-year-old man comes to the physician complaining of occasional chest pain that occurs with strenuous activity. He is obese and has a history of hypertension and diabetes mellitus. During the physical examination, he admits to eating most of his meals at fast food restaurants. He also reports he has little time for exercise.

案例2：58岁男性患者主诉体力活动后偶发胸痛，患者肥胖且有高血压、糖尿病史。体检过程中患者透露平时用餐多在快餐店，且很少运动。

1. What is the most likely diagnosis?

Stable angina, characterized by chest pain with exertion, is often secondary to atherosclerosis.

动脉粥样硬化（冠心病心绞痛）

诊断：危险因素+典型症状+扩冠抗凝治疗有效

2. What risk factors increase a person’s likelihood of developing this condition?

Major: Hypertension, diabetes, advanced age, gender, and hyperlipidemia.

Minor: Family history, smoking

危险因素: 最主要→高血压、糖尿病、老年、男性、高脂血症；次要→家族史、吸烟

3. What is the pathophysiology of this condition?

Endothelial injury, release of growth factors, foam cells development and complex atheromas with calcification and ischemia.

病理生理表现：危险因素所致内皮损伤+生长因子释放+内膜平滑肌细胞增生+泡沫细胞形成及动脉粥样化复合体形成

4. Which arteries are most commonly affected in this condition?

Branching points of arteries or areas of turbulent blood flow including coronary artery, popliteal, renal artery and the circle of Willis.

主要累及部位：动脉分支部位+血液涡流区

5. What are the major forms of angina?

Stable angina: chest pain with exertion

Unstable angina: chest pain at rest, secondary to thrombus in a branch.

Prinzmetal angina: chest pain at rest, secondary to coronary artery spasm.

主要类型：

稳定型心绞痛→劳累时发生+硝酸甘油治疗有效

不稳定型心绞痛→休息时发生，与血栓有关+硝酸甘油可能无效+肝素/溶栓

变异型心绞痛→休息时发生，与冠脉痉挛有关+钙离子拮抗剂(CCB)治疗

词汇拾零

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