自发性冠状动脉夹层研究进展

Research progress on spontaneous coronary artery dissection

自发性冠状动脉夹层(Spontaneous coronary artery dissection,SCAD)是由血管内膜破坏或血管出血引起的非医源性和非创伤性的冠状动脉壁自发分离,其机制尚不清晰。近年来,SCAD作为妊娠期或产后心肌梗死(Myocardual infarction,MI)最常见的病因,受重视程度逐渐增高。本文系统检索了各大数据库并筛选相关文献后,对迄今SCAD的流行病学、病因及发病机制、病理、诊断进行概述,并将血运重建与药物保守治疗的预后结局差异进行比较。目前认为SCAD作为一种非传统的心肌梗死类型,缺乏典型的临床特征,临床容易误诊漏诊,关于最优治疗方案的证据尚待研究者探索。

Spontaneous coronary artery dissection(SCAD)is a kind of epicardial coronary artery dissection that is not associated with atherosclerosis,trauma or iatrogenic injuries.The mechnism of SCAD is still unclear.In rencent years,as a dominant cause of myocardial infarction(MI)amongwomenduringpregnancy and perinatal stage,the increased awareness of SCAD has been evoked.This review searched the Pubmed,Embase,Cochrane Library and Web of Science systematically and identified the overall results of our search strategy.The epidemiology,etiology,mechnism,pathology and diagnosis were reviewed and summarized;the outcome of prognosis of different treatment options were compared,such as the comparison between blood transportion reconstruction and the conventional drug therapy.At present,as an unconventional type of MI,the typical clinical characteristics of SCAD are not obvious,misdiagnosis may occur.For better treatment approach,it needs greater efforts and further exploration.