基础医学与临床 ›› 2018, Vol. 38 ›› Issue (11): 1644-1648.

• 短篇综述 • 上一篇    下一篇

左室流出道梗阻合并消化道出血的研究进展

于琛1,赵彧墨1,吴东2   

  1. 1. 中国医学科学院 北京协和医学院 北京协和医院
    2. 中国医学科学院北京协和医学院北京协和医院
  • 收稿日期:2018-07-17 修回日期:2018-09-19 出版日期:2018-11-05 发布日期:2018-11-22
  • 通讯作者: 吴东 E-mail:dongwu@pumc.edu.cn
  • 基金资助:
    公益性行业科研专项基金

Research progress in left ventricular outflow tract obstruction associated gastrointestinal hemorrhage

  • Received:2018-07-17 Revised:2018-09-19 Online:2018-11-05 Published:2018-11-22

摘要: 肥厚型心肌病(HCM)及主动脉瓣狭窄(AS)是左室流出道梗阻的常见病因。由于左室流出道梗阻的血流动力学改变,血流中高剪切力破坏血管性血友病因子高分子量多聚体,可引起获得性血管性血友病,继而在伴/不伴消化道血管发育不良的情况下,增加消化道出血风险。针对AS或HCM的治疗如主动脉瓣置换术、室间隔部分切除术或化学消融术可显著降低消化道出血的再发风险。目前对于左室流出道梗阻合并消化道出血在流行病学、发病机制、临床表现及诊治等方面的了解尚不够深入。

关键词: 肥厚型心肌病, 血管发育不良, 消化道出血, 获得性血管性血友病, 海德综合征

Abstract: Hypertrophic cardiomyopathy (HCM) and aortic stenosis (AS) are common causes of left ventricular outflow tract (LVOT) obstruction. Hemodynamic changes in HCM or AS cause shear-induced destruction of high molecular weight von Willebrand factor, which leads to acquired von Willebrand factor syndrome (AvWS). This in turn increases risk of gastrointestinal hemorrhage, with or without secondary angiodysplasia. Treatment like aortic valve replacement, septal myectomy or alcohol septal ablation are ideal for patients with LVOT obstruction associated GI hemorrhage. Timely diagnosis and proper treatment relies on a thorough understanding of epidemiology and pathogeneesis of these patients.

Key words: Hypertrophic cardiomyopathy, angiodysplasia, gastrointestinal hemorrhage, acquired von Willebrand syndrome, Hyde syndrome