• 北京協(xié)和醫(yī)學(xué)院中國醫(yī)學(xué)科學(xué)院 阜外心血管病醫(yī)院外科,北京 100037;

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。心血管病變以主動脈瘤和主動脈夾層常見,也是MFS患者死亡的主要原因。目前對該病的治療主要以手術(shù)為主,但效果不盡滿意。新的研究發(fā)現(xiàn)常見的抗高血壓藥物氯沙坦對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)化生長因子-β (transforming growth factor β,TGF-β)的過度激活有關(guān),這一發(fā)現(xiàn)必將推動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. 中國胸心血管外科臨床雜志, 2012, 19(6): 668-670. doi: 復(fù)制

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. 1.  Stheneur C, Laffond C, Rioux S, et al. Recent progress in Marfan syndrome. Arch Pediatr, 2012, 19 (5):551-555.
  2. 2.  Yuan SM, Jing H. Marfan’s syndrome:an overview. Sao Paulo Med J, 2010,128 (6):360-366.
  3. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 14.  El-HamamsyⅠ, Yacoub MH. Cellular and molecular mechanisms of thoracic aortic aneurysms. Nat Rev Cardiol, 2009, 6 (12):771-786.
  15. 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. 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. 17.  Sengle G, Tsutsui K, Keene DR, et al. Microenvironmental regulation by fibrillin-1. PLoS Genet, 2012,8 (1):e1002425.
  18. 18.  Kaartinen V, Warburton D. Fibrillin controls TGF-beta activation. Nat Genet, 2003, 33 (3):331-332.
  19. 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. 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. 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. 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. 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. 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. 25.  Dean JC. Marfan syndrome:clinical diagnosis and management. Eur J Hum Genet, 2007, 15 (7):724-733.
  26. 26.  Matt P, Eckstein F. Novel pharmacological strategies to prevent aortic complications in Marfan syndrome. J Geriatr Cardiol, 2011, 8 (4):254-257.
  27. 27.  Keane MG, Pyeritz RE. Medical management of Marfan syndrome. Circulation, 2008, 117 (21):2802-2813.
  28. 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.