馬方綜合征(Marfan syndrome,MFS)是一種先天性遺傳性結(jié)締組織疾病,為常染色體顯性遺傳,具有家族積聚性。臨床主要表現(xiàn)為心血管系統(tǒng)、骨骼和眼受累, 自然病死率極高。心血管病變以主動(dòng)脈瘤和主動(dòng)脈夾層常見(jiàn),也是MFS患者死亡的主要原因。目前對(duì)該病的治療主要以手術(shù)為主,但效果不盡滿(mǎn)意。新的研究發(fā)現(xiàn)常見(jiàn)的抗高血壓藥物氯沙坦對(duì)MFS有良好的治療效果。氯沙坦的作用機(jī)制很可能與抑制轉(zhuǎn)化生長(zhǎng)因子-β (transforming growth factor β,TGF-β)的過(guò)度激活有關(guān),這一發(fā)現(xiàn)必將推動(dòng)MFS治療方式從傳統(tǒng)的手術(shù)治療向藥物治療轉(zhuǎn)變。我們對(duì)MFS發(fā)病的分子生物學(xué)基礎(chǔ)、傳統(tǒng)的治療方法以及新的治療方法進(jìn)行綜述。
引用本文: 公兵,楊秀濱. 馬方綜合征血管病變的治療進(jìn)展. 中國(guó)胸心血管外科臨床雜志, 2012, 19(6): 668-670. doi: 復(fù)制
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1. | Stheneur C, Laffond C, Rioux S, et al. Recent progress in Marfan syndrome. Arch Pediatr, 2012, 19 (5):551-555. |
2. | Yuan SM, Jing H. Marfan’s syndrome:an overview. Sao Paulo Med J, 2010,128 (6):360-366. |
3. | Lebreiro A, Martins E, Cruz C, et al. Marfan syndrome:clinical manifestations, pathophysiology and new outlook on drug therapy. Rev Port Cardiol, 2010, 29 (6):1021-1036. |
4. | Chung AW, Au Yeung K, Sandor GG, et al. Loss of elastic fiber integrity and reduction of vascular smooth muscle contraction resulting from the upregulated activities of matrix metalloproteinase-2 and-9 in the thoracic aortic aneurysm in Marfan syndrome. Circ Res, 2007, 101 (5):512-522. |
5. | Merk DR, Chin JT, Dake BA, et al. miR-29b participates in early aneurysm development in marfan syndrome. Circ Res, 2012, 110 (2):312-324. |
6. | Holm TM, Habashi JP, Doyle JJ, et al. Noncanonical TGFβ signaling contributes to aortic aneurysm progression in Marfan syndrome mice. Science, 2011, 332 (6027):358-361. |
7. | Brooke BS, Habashi JP, Judge DP, et al. Angiotensin II blockade and aortic-root dilation in Marfan’s syndrome. N Engl J Med, 2008, 358 (26):2787-2795. |
8. | Habashi JP, Judge DP, Holm TM, et al. Losartan, an AT1 antag onist, prevents aortic aneurysm in a mouse model of Marfan syndrome. Science, 2006, 312 (5770):117-121. |
9. | Hartog AW, Franken R, Zwinderman AH, et al. Current and future pharmacological treatment strategies with regard to aortic disease in Marfan syndrome. Expert Opin Pharmacother, 2012, 13 (5):647-662. |
10. | Shimizu H, Kasahara H, Nemoto A, et al. Can early aortic root surgery prevent further aortic dissection in Marfan syndrome?? Interact Cardiovasc Thorac Surg, 2012, 14 (2):171-175. |
11. | Geisbuesch S, Schray D, Bischoff MS, et al. Frequency of reoperations in patients with Marfan syndrome. Ann Thorac Surg, 2012, 93 (5):1496-1501. |
12. | Zhang L, Gao LG, Zhang M, et al. Genotype-phenotype analysis of F-helix mutations at the kinase domain of TGFBR2, including a type 2 Marfan syndrome familial study. Mol Vis, 2012,18:55-63. |
13. | Neptune ER, Frischmeyer PA, Arking DE, et al. Dysregulation of TGF-beta activation contributes to pathogenesis in Marfan syndrome. Nat Genet, 2003, 33 (3):407-411. |
14. | El-HamamsyⅠ, Yacoub MH. Cellular and molecular mechanisms of thoracic aortic aneurysms. Nat Rev Cardiol, 2009, 6 (12):771-786. |
15. | ten Dijke P, Arthur HM. Extracellular control of TGFbeta signalling in vascular development and disease. Nat Rev Mol Cell Biol, 2007, 8 (11):857-869. |
16. | Le Goff C, Cormier-Daire V. From tall to short:the role of TGFβ signaling in growth and its disorders. Am J Med Genet C Semin Med Genet, 2012,160 (3):145-153. |
17. | Sengle G, Tsutsui K, Keene DR, et al. Microenvironmental regulation by fibrillin-1. PLoS Genet, 2012,8 (1):e1002425. |
18. | Kaartinen V, Warburton D. Fibrillin controls TGF-beta activation. Nat Genet, 2003, 33 (3):331-332. |
19. | Yang Y, Cui Y, Peng DQ. ARB May be superior to ACEI on treatment of Marfan’s syndrome by blocking TGF-β mediated activation of ERK. Int J Cardiol, 2012, 155 (3):482-483. |
20. | Aalberts JJ, Thio CH, Schuurman AG, et al. Diagnostic yield in adults screened at the Marfan outpatient clinic using the 1996 and 2010 Ghent nosologies. Am J Med Genet A, 2012, 158A (5):982-988. |
21. | Radonic T, de Witte P, Baars MJ, et al. Losartan therapy in adults with Marfan syndrome:study protocol of the multi-center randomized controlled compare trial. Trials, 2010,11:3. |
22. | Detaint D, Aegerter P, Tubach F, et al. Rationale and design of a randomized clinical trial (Marfan Sartan) of angiotensinⅡreceptor blocker therapy versus placebo in individuals with Marfan syndrome. Arch Cardiovasc Dis, 2010, 103 (5):317-325. |
23. | Gambarin FI, Favalli V, Serio A, et al. Rationale and design of a trial evaluating the effects of losartan vs. nebivolol vs. the association of both on the progression of aortic root dilation in Marfan syndrome with FBN1 gene mutations. J Cardiovasc Med (Hagerstown), 2009, 10 (4):354-362. |
24. | Lacro RV, Dietz HC, Wruck LM, et al. Rationale and design of a randomized clinical trial of beta-blocker therapy (atenolol) versus angiotensinⅡreceptor blocker therapy (losartan) in individuals with Marfan syndrome. Am Heart J, 2007, 154 (4):624-631. |
25. | Dean JC. Marfan syndrome:clinical diagnosis and management. Eur J Hum Genet, 2007, 15 (7):724-733. |
26. | Matt P, Eckstein F. Novel pharmacological strategies to prevent aortic complications in Marfan syndrome. J Geriatr Cardiol, 2011, 8 (4):254-257. |
27. | Keane MG, Pyeritz RE. Medical management of Marfan syndrome. Circulation, 2008, 117 (21):2802-2813. |
28. | Pyeritz RE, Loeys B. The 8th international research symposium on the Marfan syndrome and related conditions. Am J Med Genet A, 2011,158:42-49. |
- 1. Stheneur C, Laffond C, Rioux S, et al. Recent progress in Marfan syndrome. Arch Pediatr, 2012, 19 (5):551-555.
- 2. Yuan SM, Jing H. Marfan’s syndrome:an overview. Sao Paulo Med J, 2010,128 (6):360-366.
- 3. Lebreiro A, Martins E, Cruz C, et al. Marfan syndrome:clinical manifestations, pathophysiology and new outlook on drug therapy. Rev Port Cardiol, 2010, 29 (6):1021-1036.
- 4. Chung AW, Au Yeung K, Sandor GG, et al. Loss of elastic fiber integrity and reduction of vascular smooth muscle contraction resulting from the upregulated activities of matrix metalloproteinase-2 and-9 in the thoracic aortic aneurysm in Marfan syndrome. Circ Res, 2007, 101 (5):512-522.
- 5. Merk DR, Chin JT, Dake BA, et al. miR-29b participates in early aneurysm development in marfan syndrome. Circ Res, 2012, 110 (2):312-324.
- 6. Holm TM, Habashi JP, Doyle JJ, et al. Noncanonical TGFβ signaling contributes to aortic aneurysm progression in Marfan syndrome mice. Science, 2011, 332 (6027):358-361.
- 7. Brooke BS, Habashi JP, Judge DP, et al. Angiotensin II blockade and aortic-root dilation in Marfan’s syndrome. N Engl J Med, 2008, 358 (26):2787-2795.
- 8. Habashi JP, Judge DP, Holm TM, et al. Losartan, an AT1 antag onist, prevents aortic aneurysm in a mouse model of Marfan syndrome. Science, 2006, 312 (5770):117-121.
- 9. Hartog AW, Franken R, Zwinderman AH, et al. Current and future pharmacological treatment strategies with regard to aortic disease in Marfan syndrome. Expert Opin Pharmacother, 2012, 13 (5):647-662.
- 10. Shimizu H, Kasahara H, Nemoto A, et al. Can early aortic root surgery prevent further aortic dissection in Marfan syndrome?? Interact Cardiovasc Thorac Surg, 2012, 14 (2):171-175.
- 11. Geisbuesch S, Schray D, Bischoff MS, et al. Frequency of reoperations in patients with Marfan syndrome. Ann Thorac Surg, 2012, 93 (5):1496-1501.
- 12. Zhang L, Gao LG, Zhang M, et al. Genotype-phenotype analysis of F-helix mutations at the kinase domain of TGFBR2, including a type 2 Marfan syndrome familial study. Mol Vis, 2012,18:55-63.
- 13. Neptune ER, Frischmeyer PA, Arking DE, et al. Dysregulation of TGF-beta activation contributes to pathogenesis in Marfan syndrome. Nat Genet, 2003, 33 (3):407-411.
- 14. El-HamamsyⅠ, Yacoub MH. Cellular and molecular mechanisms of thoracic aortic aneurysms. Nat Rev Cardiol, 2009, 6 (12):771-786.
- 15. ten Dijke P, Arthur HM. Extracellular control of TGFbeta signalling in vascular development and disease. Nat Rev Mol Cell Biol, 2007, 8 (11):857-869.
- 16. Le Goff C, Cormier-Daire V. From tall to short:the role of TGFβ signaling in growth and its disorders. Am J Med Genet C Semin Med Genet, 2012,160 (3):145-153.
- 17. Sengle G, Tsutsui K, Keene DR, et al. Microenvironmental regulation by fibrillin-1. PLoS Genet, 2012,8 (1):e1002425.
- 18. Kaartinen V, Warburton D. Fibrillin controls TGF-beta activation. Nat Genet, 2003, 33 (3):331-332.
- 19. Yang Y, Cui Y, Peng DQ. ARB May be superior to ACEI on treatment of Marfan’s syndrome by blocking TGF-β mediated activation of ERK. Int J Cardiol, 2012, 155 (3):482-483.
- 20. Aalberts JJ, Thio CH, Schuurman AG, et al. Diagnostic yield in adults screened at the Marfan outpatient clinic using the 1996 and 2010 Ghent nosologies. Am J Med Genet A, 2012, 158A (5):982-988.
- 21. Radonic T, de Witte P, Baars MJ, et al. Losartan therapy in adults with Marfan syndrome:study protocol of the multi-center randomized controlled compare trial. Trials, 2010,11:3.
- 22. Detaint D, Aegerter P, Tubach F, et al. Rationale and design of a randomized clinical trial (Marfan Sartan) of angiotensinⅡreceptor blocker therapy versus placebo in individuals with Marfan syndrome. Arch Cardiovasc Dis, 2010, 103 (5):317-325.
- 23. Gambarin FI, Favalli V, Serio A, et al. Rationale and design of a trial evaluating the effects of losartan vs. nebivolol vs. the association of both on the progression of aortic root dilation in Marfan syndrome with FBN1 gene mutations. J Cardiovasc Med (Hagerstown), 2009, 10 (4):354-362.
- 24. Lacro RV, Dietz HC, Wruck LM, et al. Rationale and design of a randomized clinical trial of beta-blocker therapy (atenolol) versus angiotensinⅡreceptor blocker therapy (losartan) in individuals with Marfan syndrome. Am Heart J, 2007, 154 (4):624-631.
- 25. Dean JC. Marfan syndrome:clinical diagnosis and management. Eur J Hum Genet, 2007, 15 (7):724-733.
- 26. Matt P, Eckstein F. Novel pharmacological strategies to prevent aortic complications in Marfan syndrome. J Geriatr Cardiol, 2011, 8 (4):254-257.
- 27. Keane MG, Pyeritz RE. Medical management of Marfan syndrome. Circulation, 2008, 117 (21):2802-2813.
- 28. Pyeritz RE, Loeys B. The 8th international research symposium on the Marfan syndrome and related conditions. Am J Med Genet A, 2011,158:42-49.