平滑肌细胞与腹主动脉瘤发病机制的研究概述

Overview of Studies on Smooth Muscle Cells and the Pathogenesis of Abdominal Aortic Aneurysms

腹主动脉瘤(AAA)是一种致命的血管退行性病变,其发病机制十分复杂,根据2022版腹主动脉瘤诊断治疗专家共识,AAA特征是腹主动脉的永久性局部扩张(气球样膨胀)超过正常直径50%以上,破裂和相关的灾难性生理损伤的总死亡率超过80%。病理特征是以中膜缺陷为主的主动脉壁结构破坏。AAA的发生涉及多种病理过程,包括细胞外基质降解、炎症、氧化应激、平滑肌衰老、凋亡及表型转化。目前关于AAA的治疗,手术仍是唯一的治疗手段,现仍未有高级别证据支持药物可以有效缓解甚至逆转AAA的发展,所以需要进一步了解AAA病理生理机制。平滑肌细胞(VSMC)是动脉壁中膜最主要的细胞类型,平滑肌细胞的衰老、凋亡、炎症反应以及与平滑肌细胞有关的细胞外基质的降解共同导致血管壁受损,促进AAA的形成。本文以平滑肌为中心,表述平滑肌与腹主动脉瘤之间的关系,这可能为AAA的治疗及预防提供新的思路。

Abdominal aortic aneurysm (AAA) is a fatal vascular degenerative diseases, its pathogenesis is complex, according to the 2022 edition of expert consensus, diagnosis and treatment for abdominal aortic aneurysm AAA is characterized by the permanent local expansion of abdominal aorta (bal-looning inflation) than normal diameter by more than 50%, rupture and the associated total mor-tality of more than 80% of catastrophic physical damage. The pathological feature is the destruction of aortic wall structure mainly due to media defect. The occurrence of AAA involves various patho-logical processes, including extracellular matrix degradation, inflammation, oxidative stress, smooth muscle aging, apoptosis and phenotypic transformation. At present, surgery is still the only treatment for AAA, and there is still no high-level evidence to support that drugs can effectively al-leviate or even reverse the development of AAA. Therefore, it is necessary to further understand the pathophysiology of AAA. Smooth muscle cells (VSMCS) are the most important cell type in the media of arterial wall. Aging, apoptosis, inflammation and degradation of extracellular matrix re-lated to smooth muscle cells jointly lead to the damage of vascular wall and promote the formation of AAA. This paper focuses on smooth muscle and describes the relationship between smooth mus-cle and abdominal aortic aneurysm, which may provide new ideas for the treatment and prevention of AAA.