动脉硬化图象

PLAQUEPROGRESSION4Inflammatorymoleculescanpromotefurthergrowthoftheplaqueandformationofafibrouscapoverthelipidcore.Thecapdevelopswhenthemoleculesinducesmoothmusclecellsofthemediatomigratetothetopoftheintima,multiplyandproduceatough,fibrousmatrixthatgluesthecellstogether.Thecapaddstothesizeoftheplaquebutalsowallsitoffsafelyfromtheblood.PLAQUERUPTURE5Later,inflammatorysubstancessecretedbyfoamcellscandangerouslyweakenthecapbydigestingmatrixmoleculesanddamagingsmoothmusclecells,whichthenfailtorepairthecap.Meanwhilethefoamcellsmaydisplaytissuefactor,apotentclotpromoter.Iftheweakenedplaqueruptures,tissuefactorwillinteractwithclot-promotingelementsintheblood,causingathrombus,orclot,toform.Iftheclotisbigenough,itwillhalttheflowofbloodtotheheart,producingaheartattack—thedeathofcardiactissue.FibrouscapMigratingsmoothmusclecell正常动脉结构冠脉病变进展冠脉狭窄和阻塞损伤反应学说运动试验心电图运动试验动脉硬化分期血管内皮细胞免疫组化检测oxLDL白细胞积聚为何分叉处病变多发3岁男孩的冠状动脉脂质条纹SmoothMuscleCellMigrationandProliferation

动脉粥样硬化呈阶梯式发展FIGURE30–8.Mechanismsofplaquedisruption

TheArterialExtracellularMatrix

AngiogenesisinPlaques

PlaqueMineralizationCOMPLICATIONSOFATHEROSCLEROSISArterialStenosesandTheirClinicalImplications

PlaqueRuptureandThrombosis

Afibrofattyeccentriccoronaryatheroscleroticplaquewithruptureofitsthin,delicatefibrouscap(arrows),exposureofthenecroticlipidcore(NLC)tothebloodstream,andsubsequentluminalthrombosisprecipitatinganacuteischemicepisodeaorticcomplicated

atheromatouslesionGrossphotographsillustrateanaorticcomplicatedatheromatouslesionwithruptureofitsfibrouscap(FC).lipidcore(LC)M=media;T=thrombusRupturedaorticatheroscleroticplaquesAdditionalexamplesofrupturedaorticatheroscleroticplaqueswithexposureoftheirlipidcores(LC)tobloodelementsandsubsequentthrombosis.A,Therupturedendsofthefibrouscap(FC)粥样硬化形成中细胞外间质和内膜炎症的关系AschematicrelatingextracellularmatrixmetabolismtointimalinflammationduringatherogenesisTNF-a=tumornecrosisfactor-alpha;M-CSF=macrophagecolonystimulatingfactor;MCP-1=monocytechemoattractantprotein-1.外膜lipidcore脂核不稳定性冠心病血小板聚积在破裂/浸润的部位外膜lipidcore脂核血栓不稳定性冠心病血栓形成并扩展进入管腔及斑块纤维胶原合成减少，分解增多纤维帽中平滑肌细胞少脂核大，巨嗜细胞含量多ThrombosisDuetoSuperficialErosionoflaques

Superficialerosionofexperimentalatheroscleroticlesionsshownbyscanningelectronmicroscopy.A,Inthelow-powerview,therentinendotheliumisevident.Leukocyteshaveadheredtothesubendothelium,whichisbeginningtobecoveredwithacarpetofplatelets.B,Thehigh-powerviewshowsafieldselectedfromthecenterofAthatshowstheleukocytesandplateletsadherenttothesubendothelium.Plateletthrombuscomplicatingaplaquedisruption

inexperimentalatherosclerosis

Thistransmissionelectronmicrographshowsacrosssectionofmacrophagestuddedwithplateletsthathaveclumpedtoformamicroscopicthrombus.SPECIALCASESOFARTERIOSCLEROSIS

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