Pathogenesis of atherosclerosis
Pathogenesis of atherosclerosis
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DOI：
10.1016/j.jacc.2005.09.068
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发表时间：
2006-04-18
影响因子：
24
通讯作者：
Falk, E
中科院分区：
文献类型：
--
作者：
Falk, E
动脉粥样硬化是一种多灶性、郁积性、免疫炎症性疾病，由脂质引起的中型和大型动脉。内皮细胞、白细胞和内膜平滑肌细胞是这种疾病发展的主要参与者。动脉粥样硬化最具破坏性的后果，如心脏病发作和中风，是由叠加血栓形成引起的。因此，重要的问题不是动脉粥样硬化为什么会发展，而是为什么动脉粥样硬化在多年的缓慢发展后，突然变得复杂，并伴有管腔血栓形成。如果能检测到易形成血栓的斑块并避免血栓形成，动脉粥样硬化将是一种良性得多的疾病。大约76%的致命性冠状动脉血栓由斑块破裂引起。斑块破裂是男性冠状动脉血栓形成的更常见原因（相似于80%），而不是女性（相似于60%）。破裂斑块的特征在于大的富含脂质的核心、含有少量平滑肌细胞和许多巨噬细胞的薄纤维帽、血管生成、外膜炎症和向外重塑。斑块破裂是冠状动脉血栓形成的最常见原因。破裂斑块和由此推断的易破裂斑块具有特征性的病理解剖学特征，这些特征可能有助于通过成像在体内进行检测。本文介绍了动脉粥样硬化的发病机制，它是如何引起血栓形成的，以及检测血栓形成倾向的斑块和预防心脏病发作的可能性。
Atherosclerosis is a multifocal, smoldering, immunoinflammatory disease of medium-sized and large arteries fuelled by lipids. Endothelial cells, leukocytes, and intimal smooth muscle cells are the major players in the development of this disease. The most devastating consequences of atherosclerosis, such as heart attack and stroke, are caused by superimposed thrombosis. Therefore, the vital question is not why atherosclerosis develops but rather why atherosclerosis, after years of indolent growth, Suddenly becomes complicated with luminal thrombosis. If thrombosis-prone plaques could be detected and thrombosis averted, atherosclerosis Would be a much more benign disease. Approximately 76% of all fatal coronary thrombi are precipitated by plaque rupture. Plaque rupture is a more frequent cause of coronary thrombosis in men (similar to 80%) than in women (similar to 60%). Ruptured plaques are characterized by a large lipid-rich core, a thin fibrous cap that contains few smooth muscle cells and many macrophages, angiogenesis, adventitial inflammation, and outward remodeling. Plaque rupture is the most common cause of coronary thrombosis. Ruptured plaques and, by inference, rupture-prone plaques have characteristic pathoanatomical features that might be useful for their detection in vivo by imaging. This article describes the pathogenesis of atherosclerosis, how it begets thrombosis, and the possibility to detect thrombosis-prone plaques and prevent heart attack.