儿童白癫疯怎么治 http://m.39.net/pf/a_4657304.htmlArterialTortuosityHypertensionreview-articleMay01,:73(5),–./HYPERTENSIONAHA..本文由“天纳”临床学术信息人工智能系统自动翻译点击文末“阅读原文”下载本文PDFArterialtortuosity,thatis,thepresenceofabnormaltwistsandturnsofoneorseveralarterieshasbeenrecognizedfordecadesandassociatedwitholderage,femalesex,highbloodpressure,andothercardiovascularriskfactors.1,2Therecentidentificationofarterialtortuosityasahallmarkofgeneticarteriopathies,suchasLoeys-Dietzsyndrome(LDS)3togetherwiththedemonstrationofanassociationofarterialtortuositywithspontaneouscoronaryarterydissection(SCAD)andfibromusculardysplasia(FMD),4haveshednewlightonthisoldphenotype.Arterialtortuositymaybeamarkerofvascularfragilityorausefulindicatorofunderlyingarteriopathies.Assuch,itcouldfinditsplaceinthediagnosticevaluation,cardiovascularriskstratification,andprognosticassessmentofvariousvascularconditions.3–7However,incorporationofthisarterialphenotypeintoclinicalpracticerequiresstandardizationintermsofdefinition,measurement,andnormalcycriteria,aswellasfurtherevaluationinretrospectiveandprospectivestudiesinvolvingspecialistswithdifferentbackgrounds.Thescopeofthisreviewistosummarizecurrentknowledgeonarterialtortuositywithemphasisonmiddle-sizeandlargearteriesandtopavethewayforamultidisciplinaryclinicalresearchinitiativedevotedtothisintriguingvascularbiomarker.动脉迂曲，也就是说，一条或几条动脉出现异常迂曲和拐弯几十年来已被认识，并与老年、女性、高血压和其他心血管危险因素有关。1,2最近发现动脉迂曲是遗传性动脉病的标志，如LoeysDietzSy。ndrome（lds）3与动脉迂曲性与自发性冠状动脉夹层（scad）和纤维肌肉发育不良（fmd）的相关性一起，4为这一古老的表型提供了新的线索。动脉迂曲可能是血管脆弱性的标志或潜在动脉病变的有用指标。因此，它可以在各种血管疾病的诊断评估、心血管风险分层和预后评估中找到自己的位置。3-7然而，将这种动脉表型纳入临床实践需要在定义、测量和正常标准方面进行标准化，以及进一步的评估。对不同背景的专家进行回顾性和前瞻性研究。这篇综述的范围是总结当前关于动脉扭曲的知识，强调中大动脉，并为多学科的临床研究计划铺平道路，致力于这一有趣的血管生物标志物。DefinitionandClassificationofArterialTortuosityPerhapsthefirstdescriptionofvasculartortuositycanbefoundinLeonardodaVinci’sanatomicdrawings,8whereheassociatesitwiththeprocessofaging,describingthesuperficialvesselsofthearmastortuousintheoldasopposedtothevesselsoftheyoung,presentedasstraight(FigureS1intheonline-onlyDataSupplement).也许血管扭曲的第一个描述可以在列奥纳多·达·芬奇的解剖图8中找到，他将其与衰老过程联系起来，将手臂的表面血管描述为老年人的扭曲血管，而不是年轻人的血管，呈现为直的（图s1，在线唯一的数据补充）。Tortuositymayaffectvirtuallyanyarterialbed,fromsmallsizevessels,suchassubungualcapillariesandretinalarteriestomiddleandlargesizearteries,suchasthecoronary,cerebrovascularoriliacvessels,aswellastheaortaitself.Itcanbeeitherlocalizedtoasinglevesselorwidespread,inthelattercase,usuallyreflectingthepresenceofanunderlyingarteriopathy.Itmaybediagnosedatvariousagesandprogressovertime.扭曲几乎可以影响任何动脉床，从小血管，如软骨下毛细血管和视网膜动脉到中大动脉，如冠状动脉、脑血管或髂血管，以及主动脉本身。它可以局限于单个血管，也可以广泛分布，在后一种情况下，通常反映出潜在的动脉病变。随着时间的推移，它可能在不同的年龄和进展中被诊断出来。Avarietyoftermshavebeenusedtodescribedifferenttypesofarterialtortuosity.In,WeibelandFields9proposedaclassificationforthemorphologicalvariationoftheinternalcarotidartery.TheydefinedtortuosityasanS-orC-shapedelongationorundulation.Kinkingwasdescribedasanacuteangulation,itsseverityrangingfrommild(angle≥60°)tomoderate(anglebetween30°and60°)andsevere(angle30°).LoopinghasbeendefinedasanexaggeratedS-shapedcurveandCoilingasacircularcourse.9–11AnothertermmorerecentlyusedistheS-curve,describedasaredundancyofthemiddistalinternalcarotidarterycausinganS-shapedcurve.12SeveralotherrelatedtermsandmarkersoftortuositycanbefoundinTable1.各种术语被用来描述不同类型的动脉扭曲。年，Weibel和Fields9提出了颈内动脉形态变异的分类。他们将弯曲定义为S形或C形延伸或波动。扭结被描述为一种急性角度，其严重程度从轻度（角度≥60°）到中度（角度介于30°和60°之间）到重度（角度30°）。环路被定义为一条夸张的S形曲线，并绕成圆形。9-11最近使用的另一个术语是S形曲线，它被描述为导致S形曲线的中远端颈内动脉的冗余。12表1中还提供了一些其他相关的术语和弯曲标记。Table1.ArterialTortuosity:DefinitionsandPatternsPatternsofTortuosityDescriptionMarkersofTortuosityDescriptionTortuosity9S-orC-shapedelongationS-curvesign4InternalcarotidarteryredundancycreatinganS-shapedcurveKinking9,10AcutearterialangulationIntravesselsymmetrysign4SymmetricalcurvaturesonacoronaryarteryLooping11C-orS-shapeddeformitywith2turnsinthevesselwithangles90°Multivesselsymmetrysign(PortugueseManofWarsign)4SymmetricalcurvaturesofsimilarangleonmultiplecoronaryarteriesCoiling°turninthevesselCorkscrewsign4Helicalcourseofacoronaryartery≥°perpendiculartotheepicardialplaneBullittetal13described3patternsofvasculartortuosity:Bullitt等人13描述了3种血管扭曲模式：MechanismsofArterialTortuosityClinicalandexperimentalstudieshavedemonstratedastrongassociationbetweenvesseltortuosityandmechanicalfactors,suchasbloodpressure,bloodflow,axialtension,andwallstructuralchanges.14临床和实验研究表明，血管弯曲度与机械因素（如血压、血流、轴向张力和血管壁结构变化）之间有很强的相关性。14AnatomicAspectsArterialtortuosityislikelytodevelopfromabnormalitiesofrelativevascularelongation.15Vascularelongationmayarisefrom:aredundantvascularrouteduringprimaryarteriogenesis;amismatchbetweenarteriallengtheningandtheparallelgrowthofsurroundinganatomicstructuresduringchildhoodandadolescence;afurtherstimulustoarterialelongationoccurringinadulthood;ortheskeletalchangesofsenescence(suchasheightlossbecauseofspinaldiskandjointdegeneration).动脉扭曲可能由相对血管伸长的异常发展而来。15血管伸长可能产生于：原发性动脉发生过程中的一条多余血管路径；在儿童和青少年时期，动脉伸长与周围解剖结构的平行生长不匹配；对动脉伸长的进一步刺激。成年时发生的伸长；或衰老的骨骼变化（如椎间盘和关节退变导致的身高下降）。Thesitesandpatternsoftortuosityaredependentonkeyanatomicfactors.Theseinclude:弯曲的位置和模式取决于关键的解剖因素。这些包括：Tortuositymaybedynamic(eg,incoronaryvesselsduringsystoleversusdiastole,butalsoinotherarteriesdependingonbodyposition).Whenmeasuringtortuosity,itis,therefore,importanttoclearlystatetheconditionsofmeasurement.4弯曲可能是动态的（例如，在收缩和舒张期间的冠状动脉中，也可能在其他动脉中，取决于身体位置）。因此，测量弯曲度时，必须清楚地说明测量条件。Anoptimalassessmentofarterialtortuosityshouldtakeintoaccountallthefundamentalanatomicconsiderationsasmentionedabove.动脉扭曲度的最佳评估应考虑上述所有基本解剖因素。PathophysiologySeeintheonline-onlyDataSupplement.请参见在线数据补充。HowtoMeasureArterialTortuosityMeasuringandreportingthetortuosityofanarteryremainsachallengingtaskintheabsenceofastandardized,universallyacceptedmethod.在缺乏标准化、普遍接受的方法的情况下，测量和报告动脉的弯曲度仍然是一项具有挑战性的任务。Currently,severaltypesofmethodsareused:目前，使用了几种方法：Qualitativemethods:定性方法：Morerefined,quantitativemethods(recentlyproposed):更精细的定量方法（最近提出）：Figure1.Mostusedquantitativemethodsformeasuringarterialtortuosity.A,Tortuosityindex(TI)equalstheratiobetweenthelengthalongthecenterline(L1)andthelineardistancebetweenthe2endpoints(L2).B,Sumofanglesmethod(SOAM)isdefinedastheratiobetweenthesumofallangles(α)andthelengthalongthecenterline(L1).C,inflectioncountmetric(ICM)equalsthenumber(n)ofinflectionpoints(i)alongacurvemultipliedbythetotalpathlength(L1)anddividedbythedistancebetweentheendpoints(L2).Ofnote,thequalitativeorsemiquantitativemethods(eg,visualscores)maybepreferredtohighlysophisticatedmathematicalapproaches,atleastforclinicalpurposes.Still,the
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