老年性瓣膜性心脏病主动脉瓣狭窄课件.pptVIP

老年性瓣膜性心脏病 ---主动脉瓣狭窄;内 容;内 容;1854 William Stokes 在他的教科书 “The diseases of the heart and the aorta”中描述钙化性主动脉瓣病的特征为： (1) permanent patency of the valve in which the diameter may be increased or diminished; (2) an extreme ossific growth along the valve surrounding the ventricle, at which the valves are often destroyed; (3) an atheromatous deposit on the ventricular surface of the valve which is often seen in the context of fatty degeneration of the heart. 1904年Monchkebery 首先发现人在自然衰老过程中会出现退行性变，引起主动脉瓣的钙化、狭窄。 1910年Dewisky首先描述了二尖瓣环的钙化。 ; 1997年美国B. FENDLEY STEWART等人报道了5201例≥65岁老年人的心血管健康研究，提示经心脏超声检查，主动脉瓣硬化发生率是26%，主动脉狭窄为2%。在≥75岁的人群中，硬化发生率是37%，狭窄为2.6%。与退行性瓣膜病相关的独立危险因子包括年龄（年龄每增长十年危险增长2倍）、性别（男性为女性两倍）、吸烟（仍然吸烟者增加危险35%）和高血压（有高血压病史者危险增加20%）。其他明确的危险因子有LP（a）和LDL-C的水平。作者认为与主动脉瓣硬化和狭窄相关的临床因素明确，且类似于动脉粥样硬化的危险因素。 ;我国资料报道，301医院1986-1992年尸检心脏瓣膜病110例，中青年组未见钙化，50-60岁有轻度瓣膜钙化，而60岁以上者瓣膜钙化检出率随年龄增加而增高，且联合瓣膜病增多。老年瓣膜病与性别有关，主动脉钙化或硬化多见于男性，男女比例为2：1；二尖瓣环钙化多见于女性，1：2。 ;AS 在老年人是最为常见的心脏瓣膜病变 年龄65岁人群，钙化性AS为2%-7% 80%的症状性AS为男性 ;正常主动脉瓣膜;Freeman and Otto Calcific Aortic Valve Disease Circulation June 21, 2005 ;Potential pathways depicting calcific aortic valve disease. T lymphocytes and macrophages infiltrate endothelium and release cytokines that act on valvular fibroblasts to promote cellular proliferation and extracellular matrix remodeling. A subset of valvular fibroblasts within fibrosa layer differentiate into myofibroblasts that possess characteristics of smooth muscle cells. LDL that is taken into the subendothelial layer is oxidatively modified and taken up by macrophages to become foam cells. ACE is colocalized with apolipoprotein B (ApoB) and facilitates conversion of angiotensin II (AngII), which acts on angiotensin 1 receptors (AT-1R), expressed on valvular myofibroblasts. A subset of valvular myofibroblasts differentiate into osteoblast phenotype that is capable of promoting calcium nodule and bone formation. IL indicates interleukin; TGF, transforming growth factor; and MMP, matrix met