全身血流动力学动脉粥样硬化血栓综合征研究进展

doi:10.3877/cma.j.issn.2095-8757.2025.04.008

全身血流动力学动脉粥样硬化血栓综合征（SHATS）是一类由中心动脉压和血流所产生的脉动血流动力学应力[即血压变异性（BPV）]联合多种血栓及代谢性危险因素相互作用、协同驱动所致的全身动脉粥样硬化性血管疾病综合征，常伴有心、脑、肾等多个靶器官损害。BPV和动脉疾病的评估和干预不仅可以延缓年轻患者进展为高血压，还可以降低老年患者发生心血管疾病和器官损伤的风险。此文系统综述SHATS的病理生理机制，包括BPV与动脉僵硬之间的恶性循环，及其对靶器官的损害和心血管事件风险的影响，并对SHATS的诊断标准、评分及治疗策略进行总结和展望，以期深化临床对SHATS的理解，为心血管风险的早期识别与干预提供新视角。

关键词: 心血管事件, 全身血流动力学动脉粥样硬化血栓综合征, 血压变异性, 动脉僵硬, 靶器官损害

Systemic hemodynamic atherosclerotic thrombosis syndrome (SHATS) is a syndrome of systemic atherosclerotic vascular diseases. It is caused by the pulsatile hemodynamic stress (i.e., blood pressure variability, BPV) generated by central arterial pressure and blood flow, combined with multiple thrombotic and metabolic risk factors, and driven by their interaction and synergy. It often leads to damage in multiple target organs such as the heart, brain, and kidneys. Assessment and intervention for BPV and arterial diseases can not only delay the progression to hypertension in young patients but also reduce the risk of cardiovascular disease and organ damage in elderly patients. This article systematically reviews the pathophysiological mechanisms of SHATS, including the vicious cycle between BPV and arterial stiffness, as well as its impact on target organ damage and cardiovascular event risk. It also summarizes and provides an outlook on the diagnosis, scoring criteria, and treatment of SHATS, aiming to deepen the clinical understanding of SHATS and offer new perspectives for the early identification and intervention of cardiovascular risk.

Key words: Cardiovascular events, Systemic hemodynamic-atherothrombotic syndrome, Blood pressure variability, Arterial stiffness, Target organ damage

表1 全身血流动力学动脉粥样硬化血栓综合征评分表

组成部分	分值
一、血压评分	总分10分
（一）诊室血压	最高2分
1. SBP≥140 mmHg	1分
2.诊室SBPV升高：最大SBP≥180 mmHg、就诊间标准差≥20 mmHg、体位性血压变化（从静坐基线到活动站立状态的血压变化）≥20 mmHg或季节性血压变化（冬季SBP减去夏季SBP）<0 mmHg或≥20 mmHg	1分
（二）家庭血压	最高3分
1.家庭SBP升高：清晨/晚上SBP≥135 mmHg，或夜间SBP（可通过ABPM或家庭血压监测测量）≥120 mmHg	2分
2.家庭SBPV升高：晨间/晚间最高SBP≥180 mmHg、夜间最高SBP≥160 mmHg、晨晚间血压差≥20 mmHg、日间变异系数≥6.1%，或季节性变异（冬季SBP减夏季SBP）< 0 mmHg或≥9.1 mmHg	1分
（三）动态血压监测：当未进行ABPM时，ABPM与昼夜节律变化总分计1分	最高3分
1.动态SBP升高：日间/晨间SBP≥135 mmHg，夜间SBP（可通过ABPM或家庭血压监测测量）≥120 mmHg，或24 h平均SBP≥130 mmHg	2分
2.动态监测的SBPV高：日间SBP≥180 mmHg、夜间最高SBP≥160 mmHg，或加权标准差≥20 mmHg	1分
（四）昼夜节律变化：昼夜节律变化通过ABPM评估	最高2分
1.反杓型模式	2分
2.超杓型血压或晨峰血压	1分
（五）心房颤动：当存在房颤（计分为5分）时，SBPV计分与昼夜节律变化计分均计为0分	1分
二、血管评分	总分10分
（一）CVD：包括脑卒中、冠状动脉疾病、心力衰竭、主动脉瓣狭窄、认知功能障碍或外周动脉疾病/主动脉夹层	最高5分
1. 1种CVD	1分
2. 2种CVD	2分
3. 3种或以上CVD	5分
（二）无症状CVD^a	最高3分
1. 1种异常发现	1分
2. 2种异常发现	1分
3. ≥3种异常发现	1分
（三）微血管疾病	最高2分
1.糖尿病相关的CKD蛋白尿[eGFR < 60 mL·min^-1·（1.73 m²）^-1]	1分
2.小动脉硬化性视网膜病变	1分

表1 全身血流动力学动脉粥样硬化血栓综合征评分表

组成部分	分值
一、血压评分	总分10分
（一）诊室血压	最高2分
1. SBP≥140 mmHg	1分
2.诊室SBPV升高：最大SBP≥180 mmHg、就诊间标准差≥20 mmHg、体位性血压变化（从静坐基线到活动站立状态的血压变化）≥20 mmHg或季节性血压变化（冬季SBP减去夏季SBP）<0 mmHg或≥20 mmHg	1分
（二）家庭血压	最高3分
1.家庭SBP升高：清晨/晚上SBP≥135 mmHg，或夜间SBP（可通过ABPM或家庭血压监测测量）≥120 mmHg	2分
2.家庭SBPV升高：晨间/晚间最高SBP≥180 mmHg、夜间最高SBP≥160 mmHg、晨晚间血压差≥20 mmHg、日间变异系数≥6.1%，或季节性变异（冬季SBP减夏季SBP）< 0 mmHg或≥9.1 mmHg	1分
（三）动态血压监测：当未进行ABPM时，ABPM与昼夜节律变化总分计1分	最高3分
1.动态SBP升高：日间/晨间SBP≥135 mmHg，夜间SBP（可通过ABPM或家庭血压监测测量）≥120 mmHg，或24 h平均SBP≥130 mmHg	2分
2.动态监测的SBPV高：日间SBP≥180 mmHg、夜间最高SBP≥160 mmHg，或加权标准差≥20 mmHg	1分
（四）昼夜节律变化：昼夜节律变化通过ABPM评估	最高2分
1.反杓型模式	2分
2.超杓型血压或晨峰血压	1分
（五）心房颤动：当存在房颤（计分为5分）时，SBPV计分与昼夜节律变化计分均计为0分	1分
二、血管评分	总分10分
（一）CVD：包括脑卒中、冠状动脉疾病、心力衰竭、主动脉瓣狭窄、认知功能障碍或外周动脉疾病/主动脉夹层	最高5分
1. 1种CVD	1分
2. 2种CVD	2分
3. 3种或以上CVD	5分
（二）无症状CVD^a	最高3分
1. 1种异常发现	1分
2. 2种异常发现	1分
3. ≥3种异常发现	1分
（三）微血管疾病	最高2分
1.糖尿病相关的CKD蛋白尿[eGFR < 60 mL·min^-1·（1.73 m²）^-1]	1分
2.小动脉硬化性视网膜病变	1分

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