炎症反应在易损斑块中的作用及其机制研究进展

炎症反应在易损斑块的形成和进展中发挥重要作用,同时调控血管局部病变及全身炎症状态。一些促炎性细胞和炎症因子使斑块纤维帽的抗张强度降低,坏死脂质内核增大,血管机械稳定性丧失和斑块破裂;另一方面,炎症反应的激活和代谢紊乱也会引起内皮功能不全、斑块侵蚀进而导致血栓形成。该过程主要由巨噬细胞和淋巴细胞等多种炎症细胞参与,并受到多种因素调控,包括胆固醇结晶和脂质递质、血管剪切力、血管新生及斑块内出血等。此外,机体还存在一些抑炎性分子,能避免易损斑块向破裂或侵蚀进展。促炎和抗炎反应的平衡影响急性冠状动脉事件的发生。因此,以炎症反应为靶点,筛选出有易损斑块的患者并干预,或可减少急性冠状动脉事件的发生和改善预后,具有重要临床价值。

Research progress on the role of inflammatory response in vulnerable plaque and its mechanism

Inflammatory response plays an important part in the formation and progression of vulnerable plaque. It regulates the lesions locally in the artery as well as the global inflammatory status. Some pro-inflammatory cells and cytokines can reduce the tensile strength of the collagen cap surrounding the plaque and enlarge the necrotic lipid core, thus causing the loss of mechanical stability and plaque rupture. On the other hand, activation of inflammatory response and metabolic disturbance can also instigate endothelial dysfunction, plaque erosion, and further thrombosis. Such process is mediated by several immune cells such as macrophages and lymphocytes, along with other regulatory factors consisting of cholesterol crystals and lipid mediators, shear stress as well as angiogenesis and intraplaque haemorrhage. Moreover, several anti-inflammatory factors are found able to protect the vulnerable plaque from rupture or erosion, highlighting the balance of inflammatory response is essential for the occurrence of acute coronary syndrome (ACS). Thus, targeting specific factors in the inflammatory response may be valuable in screening and treating patients with vulnerable plaque, preventing ACS and improving the prognosis.