Investigation Into The Role And Mechanism Of Estrogen In Aortic Dissection Formation

Part One The Clinical features and prognosis of aortic dissection with different types, gender and estrogen levelsObjective:To summarize the epidemiological characteristics and prognosis of patients with aortic dissection in different types, gender and estrogen levels.Method:Clinical data of patients with AD who underwent surgical treatment in our hospital from December 2014 to January 2011 was retrospectively analyzed, and they are respectively divided into group of Type A aortic dissection and Type B aortic dissection; group of male and female; group of male, premenopausal and postmenopausal women in Type A aortic dissection; group of male, premenopausal and postmenopausal women in Type B aortic dissection. Their clinical features, surgical methods, postoperative complications, and short-term prognosis.are compared with each other.Result:there are 364 people who underwent surgical treatment of AD in our hospital,301 male and 63 female, male to female ratio up to 4.9:1, the average age of female group is (53.7+9.6y) greater than that in male group (48.2+10.9y). In Type A aortic dissectionthe group of postmenopausal women have a higher incidence of hypertension, hyperlipaemia then the group of male and premenopausal women, the group of postmenopausal women have a higher incidence of atherosclerosis then the group of premenopausal women, the group of male have a higher WBC then the group of premenopausal women, the group of postmenopausal women have a higher incidence of acute renal failure then the group of male,while the other perioperative complications and mortality are not significantly different between the three groups. In Type B aortic dissection, the incidence rate of hypertension in the group of postmenopausal women is higher then the group of premenopausal women and male, while there are no significantly difference between the three groups in perioperative complications and mortality.Conclusion:Male patients with aortic dissection were more than female, while the average age was less than female patients. Estrogen may potect patients from arotic dissection by reduce the risk of hypertension, hyperlipidemia, atherosclerosis, or suppressing inflammation of vessel. Postmenopausl female patients with type A aortic dissection are not typical symptoms, leading to the onset of admission time longer than men, may increase the incidence of mortality and morbidity rate of them. Postmenopausal women who underwent surgical treatment for AD may be at high risk for acute renal failure. The history of smoking and drinking in men is much higher than that in women, which may be result in the high incidence of AD in men.Fart two Expression of estrogen receptor in dissected aorta and its significanceObjective:To observe the expression of estrogen receptor in dissected aorta and discuss its role and possible mechanism in aortic dissection.Method:Victoria blue and immunohistochemical staining was conducted to investigate the histopathological changes of dissected aorta together with the expression of estrogen receptor, Western blot was applied to analysis the expression of estrogen receptor, connective tissue growth factor, matrix metallopeptidase-2 and matrix metallopeptidase-9. The correlation between estrogen receptor and CTGF, MMP-2, MMP-9 was analyzed by linear regression.Result:Collagen deposition was increased while more elastic fiber was fragmented, both were disarranged in aortic dissection. Estrogen receptor was observed in normal and dissected aorta, estrogen receptor beta was down-regulated in aortic dissection (P<0.01), while the expression of CTGF, MMP-2, and MMP-9 were elevated (P<0.05). Linear regression revealed significant correlation between estrogen receptor beta and CTGF, MMP-2, MMP-9 (P<0.05), correlation between CTGF and MMP-9 was also statistically significant (P<0.05)Conclusion:Estrogen receptor beta was down-regulated in dissected aorta, which may increase the susceptibility for aortic dissection caused by extracellular matrix reconstruction via up-regulation of CTGF and MMP-9.