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湿邪问题可直接影响到皮肤 http://www.zgbdf.net/baidianfengjiankangzixun/gedijiankang/35548.html fromvesselwallpathologytotherapeuticapproach Abstract摘要 Ananeurysmisafocaldilatationofanarterialbloodvessel.Luminalforces,suchashighbloodflow,shearstressandturbulence,areimplicatedinthepathogenesisofintracranialaneurysms,andluminalcharacteristics,suchassacsizeandmorphology,areusuallyessentialtotheclinicaldecision-makingprocess.Despitefrequentclinicalemphasisonthevessellumen,however,thepathologyunderlyingtheformation,growthandruptureofananeurysmmainlyresidesinthevesselwall.Researchonthemorphologyandhistopathologyofthevesselwallrevealsthatintracranialaneurysmsdonotconstituteasingledisease,butareasharedmanifestationofawiderangeofdiseases,eachofwhichhasauniquenaturalhistoryandoptimumtherapy.ThisReviewclassifiesintracranialaneurysmsbyvesselwallpathology,anddemonstratesthatunderstandingthemorphologyandpathologyofthisstructureisimportantindeterminingthetherapeuticapproach.Thearticleconcludesthataneurysmsrepresentasymptomofanunderlyingvasculardiseaseratherthanconstitutingadiseaseontheirown. 动脉瘤是动脉血管的局灶性扩张。颅内动脉瘤的发病机制涉及诸如高血流量，剪切应力和湍流之类的发光力，而诸如囊大小和形态之类的腔特征通常是临床决策过程必不可少的。尽管临床上经常强调血管腔，但是动脉瘤形成，生长和破裂的病理学主要存在于血管壁中。对血管壁的形态学和组织病理学的研究表明，颅内动脉瘤不是单一疾病，而是多种疾病的共同表现，每种疾病都有独特的自然病史和最佳治疗方法。本综述通过血管壁病理学对颅内动脉瘤进行分类，并证明了解这种结构的形态和病理学对于确定治疗方法很重要。该文章的结论是，动脉瘤代表潜在的血管疾病的症状，而不是单独构成疾病。 Introduction引言 Thepathogenesisofintracranialarterialaneurysmshasbeendebatedformanyyearsandremainsunclear.Theselesionscanposelife-threateningriskstopatients,sounderstandingtheircauseandprogressionisimportantforchoosingtherighttreatment.Thegeneralassumptionthatthearterialbloodstreamfirst‘expands’andthen‘bursts’ananeurysmalherniationofthevesselwall1mightbecorrect;however,thisassumptiondoesnotdistinguishamongthediversediseasesthatgiverisetoarterialaneurysms,andmight,therefore,constituteasimplisticapproachconfoundingasymptom(thatis,theaneurysm)withthedisease.Clinicalmanagementstrategiesthatrelysolelyonluminalcharacteristics(suchasthesizeandlocationoftheaneurysm)mightfailtodifferentiateaneurysmsintosubclassesthathavesimilarmorphologicalfeaturesbutexhibitdifferentnaturalhistories.2Evaluationofthepathogenesisofaneurysmsonthebasisofluminalforces—suchashighbloodflow,shearstressandturbulence—alonemayconcealotherequallyimportantabluminalfactors,suchasmorphologicalorbiologicalphenomenawithinthevesselwall,ortheperianeurysmalenvironment.3–6Althoroughunderstandingofaneurysmsmight,therefore,beobtainedonevaluationofthemorphologicalandhistopathologicalcharacteristicsofthevesselwall. 颅内动脉瘤的发病机制已经争论了很多年，目前还不清楚。这些病变可能给患者带来生命危险，因此了解其病因和进展对于选择正确的治疗方法很重要。一般的假设是，动脉血流先“扩张”然后“爆发”血管壁的动脉瘤凸出1可能是正确的；但是，该假设不能区分引起动脉瘤的多种疾病，因此可能构成一种将疾病的症状（即动脉瘤）混淆的简单方法。仅依靠腔特征（例如动脉瘤的大小和位置）的临床管理策略可能无法将动脉瘤区分为具有相似的形态特征但表现出不同自然历史的亚类。2根据腔的评估动脉瘤的发病机理诸如高血流量，剪切应力和湍流之类的作用力可能会掩盖其他同样重要的无血管畸形因素，例如血管壁内的形态或生物学现象或动脉瘤周围环境。3-6因此，对动脉瘤的透彻了解可能会通过评估血管壁的形态和组织病理学特征获得。 InthisReview,weaimtodescribetheneuroimagingfeaturesusedtoidentifytheabluminal(residingwithinthevesselwall)factorsofintracranialaneurysmsthathelptoelucidatetheetiologyofthedifferentclassesofaneurysmallesion.Wealsoclassifyintracranialaneurysmsbyvesselwallpathology(Table1)todemonstratetheimportanceofthisclassificationsystemwhendeterminingthetherapeuticapproach. 在这篇综述中，我们旨在描述用于识别颅内动脉瘤的管腔异常（位于血管壁内）的神经影像学特征，以帮助阐明不同类别的动脉瘤病变的病因。我们还通过血管壁病理学对颅内动脉瘤进行分类（表1），以证明在确定治疗方法时此分类系统的重要性。 Histologyofintracranialarteries颅内动脉组织学 Thewallsofallarteries
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