共查询到19条相似文献,搜索用时 381 毫秒
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急性冠状动脉综合征常常导致严重的心血管事件,而冠状动脉粥样硬化斑块破裂是绝大多数急性冠状动脉综合征发生的原因,因此检测高破裂风险的易损斑块,对筛选和干预急性冠状动脉综合征具有重要意义。随着研究的不断进展,易损斑块内的一些微观结构如斑块内新生血管、微小钙化、胆固醇结晶,在易损斑块的进展中起到重要的作用。因此,本文以易损斑块内最常见的3种微观结构为重点,综述斑块内微观结构在易损斑块进展中的作用。 相似文献
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动脉粥样硬化是全身性、慢性炎症性疾病,以局部突出表现为主。冠状动脉粥样硬化是冠状动脉性心脏病最主要病因,冠状动脉性心脏病患者发生急性冠状动脉事件的后果十分严重,常危及生命,而易损斑块是导致急性冠状动脉综合征主要罪犯病变。因此,对易损斑块的早期识别以及积极干预,对于预防急性心血管事件的发生至关重要,具有非常重要的临床意义。现就冠状动脉易损斑块的治疗最新进展做一综述。 相似文献
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《临床心血管病杂志》2015,(9)
急性心血管事件是致死率极高的疾病,粥样斑块破裂后血栓形成被认为是许多急性心血管事件的直接原因。在过去几十年里,光学相干断层成像(OCT)逐渐被运用于准确识别易损斑块,OCT是一种利用光学原理的血管内成像新技术,具有高分辨率及良好的组织相关性。现就将OCT评价易损斑块的应用进展做一综述。 相似文献
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斑块破裂基础上血栓形成是急性冠状动脉(冠脉)综合征发生的主要病理机制。血管内超声在心导管室中应用越来越广泛,它能够在体观察斑块组成以及识别血栓和斑块破裂,有助于加深对急性冠脉综合征的认识。但是,心血管事件发生之前常常没有先兆症状,如果我们能够在急性冠脉事件发生之前检出易损斑块,并进行临床干预使之稳定,不良心血管事件的发生将大大减少。血管内超声下,含有无回声区脂质软斑块、薄纤维帽和正性重构被认为斑块易损的标志。当然,我们不仅要关注于局部病变性质的判断和处理,而且要着眼于整个冠状动脉和相关的系统因素。 相似文献
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不良心血管事件(ACE)的发生,大部分是在动脉管腔轻至中度狭窄的基础上,由易损斑块破裂或侵蚀以及血栓形成所致。现代医学对冠状动脉粥样化性疾病的研究,已从以往仅关注管腔狭窄的程度向关注斑块的易损性转变。因此,探索易损斑块破裂的机制,早期识别易损斑块,预防ACE的发生成为心血管疾病研究领域的热点之一。近年来,大量研究发现动脉粥样硬化(AS)斑块内微钙化(microcalcifications,μCalcs)的出现与斑块的易损性关系密切,由此推测μCalcs可能是引起斑块破裂的一个重要因素。本文对AS斑块内μCalcs与易损斑块的相关性作一综述。 相似文献
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W van Lammeren G L Moll F Borst GJ de Kleijn DP P M de Vries JP Pasterkamp G 《Current Cardiology Reviews》2011,7(1):22-27
Cardiovascular disease (CVD) is the number one cause of death globally, and the majority of CVD is caused by atherosclerosis. Atherosclerosis is a systemic inflammatory disease that leads to myocardial infarction, stroke and lower limb ischemia. Pathological studies have given insight to development of atherosclerosis and the importance of local plaque vulnerability, leading to thrombus formation and cardiovascular events. Due to the burden of cardiovascular disease, identification of patients at risk for cardiovascular events and treatment stratification is needed. The predictive power of classical risk factors is limited, especially in patients with manifest atherosclerosis. Imaging modalities have focused on the characteristics of the vulnerable plaque. However, it has become evident that not all so-called vulnerable plaques lead to rupture and subsequent thrombosis. The latter obviously limits the positive predictive value for imaging assessment of plaques and patients at risk. Serum biomarkers have also been studied extensively, but have very limited application in a clinical setting for risk stratification. In line with the important relation between vulnerable plaques and cardiovascular events, plaque biomarker studies have been initiated. These longitudinal studies are based on the concept, that a vulnerable plaque contains predictive information for future cardiovascular events, also in other territories of the vascular tree. Results look promising and plaque markers can be used to develop imaging modalities to identify patients at risk, or to monitor treatment effect. Plaque biomarker studies do not challenge the definition of the vulnerable plaque, but use its concept in favor of prediction improvement for vascular patients. 相似文献
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There is a strong need for biomarkers to identify patients at risk for future cardiovascular events related with progressive atherosclerotic disease. Ideally, increasing knowledge of the mechanisms of atherosclerotic plaque destabilization should be translated in clinical practice. Currently, the following commonly followed strategies can be identified with the objective to detect either the local vulnerable plaque that is prone to rupture and gives rise to a thrombotic occlusion, or the systemic vulnerable patient, who has a high probability to suffer from an adverse clinical event. On the one hand, studies are ongoing to determine local atherosclerotic plaque characteristics to predict future local plaque rupture and subsequent vascular thrombosis. Newly developed imaging modalities are being developed and validated to detect these plaques in vivo. On the other hand, systemic approaches are pursued to discover serum biomarkers that are applicable to define patients at risk for future cardiovascular events. We propose a third original approach that is optional but yet unexplored, that is, to use local plaque characteristics as a biomarker not just for local plaque destabilization but for future cardiovascular events due to plaque progression in any vascular system. This review aims to provide an overview of the current standings of the identification of the vulnerable plaque and the vulnerable patient. 相似文献
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炎症在动脉粥样硬化(AS)中扮演重要的角色.炎症贯穿于疾病发生、发展的各个阶段,包括易损粥样斑块形成和最终的破裂.其过程涉及许多炎性细胞,如单核细胞源性巨噬细胞、T淋巴细胞及其合成和分泌的细胞因子、趋化因子和酶.这些炎性因子导致内皮细胞活化,平滑肌细胞增殖,纤维帽基质的降解而形成易损斑块.这些有关炎性因子通过各种方法 可从外周血检测到,且循环血液中的炎症因子浓度与将来的心血管事件的发生密切相关.现将易损和破裂斑块的生物标记物的最新进展进行综述. 相似文献
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Song Ding Nan Lin Xincheng Sheng Yichao Zhao Yuanyuan Su Longwei Xu Renyang Tong Yang Yan Yanan Fu Jie He Yu Gao Ancai Yuan Lei Ye Russel J. Reiter Jun Pu 《Journal of pineal research》2019,67(2)
Rupture of vulnerable plaques is the main trigger of acute cardio‐cerebral vascular events, but mechanisms responsible for transforming a stable atherosclerotic into a vulnerable plaque remain largely unknown. Melatonin, an indoleamine hormone secreted by the pineal gland, plays pleiotropic roles in the cardiovascular system; however, the effect of melatonin on vulnerable plaque rupture and its underlying mechanisms remains unknown. Here, we generated a rupture‐prone vulnerable carotid plaque model induced by endogenous renovascular hypertension combined with low shear stress in hypercholesterolemic ApoE?/? mice. Melatonin (10 mg/kg/d by oral administration for 9 weeks) significantly prevented vulnerable plaque rupture, with lower incidence of intraplaque hemorrhage (42.9% vs. 9.5%, P = 0.014) and of spontaneous plaque rupture with intraluminal thrombus formation (38.1% vs. 9.5%, P = 0.029). Mechanistic studies indicated that melatonin ameliorated intraplaque inflammation by suppressing the differentiation of intraplaque macrophages toward the proinflammatory M1 phenotype, and circadian nuclear receptor retinoid acid receptor‐related orphan receptor‐α (RORα) mediated melatonin‐exerted vasoprotection against vulnerable plaque instability and intraplaque macrophage polarization. Further analysis in human monocyte‐derived macrophages confirmed the role of melatonin in regulating macrophage polarization by regulating the AMPKα‐STATs pathway in a RORα‐dependent manner. In summary, our data provided the first evidence that melatonin‐RORα axis acts as a novel endogenous protective signaling pathway in the vasculature, regulates intraplaque inflammation, and stabilizes rupture‐prone vulnerable plaques. 相似文献
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Geometric arterial remodeling is an important determinant of luminal narrowing in atherosclerotic disease. Expansive remodeling retards while constrictive remodeling accelerates luminal narrowing by plaque formation. Cross-sectional as well as follow-up studies revealed that expansive remodeling is associated with adverse cardiovascular events and a vulnerable plaque phenotype. Although the relation between expansive remodeling and plaque vulnerability is associative rather than causal, expansively remodeled plaques should be considered as a wolf in sheep's clothes. Further understanding of the processes that regulate arterial remodeling and plaque rupture may lead to new strategies to responsibly manipulate these processes for the benefit of patient outcomes. 相似文献
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《Revista portuguesa de cardiologia》2014,33(2):101-110
Cardiovascular imaging plays an important role in the identification and characterization of the vulnerable plaque. A major goal is the ability to identify individuals at risk of plaque rupture and developing an acute coronary syndrome. Early recognition of rupture‐prone atherosclerotic plaques may lead to the development of pharmacologic and interventional strategies to reduce acute coronary events.We review state‐of‐the‐art cardiovascular imaging for identification of the vulnerable plaque. There is ample evidence of a close relationship between plaque morphology and patient outcome, but molecular imaging can add significant information on tissue characterization, inflammation and subclinical thrombosis. Additionally, identifying arterial wall exposed to high shear stress may further identify rupture‐prone arterial segments. These new modalities may help reduce the individual, social and economic burden of cardiovascular disease. 相似文献
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Serious cardiovascular events frequently arise from rupture of vulnerable atherosclerotic plaques. Not infrequently, these plaques are clinically silent and suddenly cause acute complications such as myocardial infarction, which in a high percentage are fatal. Thus, identifying individual patients with vulnerable plaques at high risk for plaque rupture is a central challenge in clinical medicine. This review highlights noninvasive scintigraphic techniques, which use radiolabeled molecules to detect functional aspects in atherosclerotic plaques by visualizing their biological activity. One major principle is the molecular imaging of inflammation with radionuclide tracers, including detection of metabolic activity, chemotaxis, cell recruitment, and lipoprotein enrichment. Additional studies focus on visualization of apoptosis, angiogenesis, or proteolysis. A central feature of plaque vulnerability is its thrombogenicity. Therefore, detection of thrombogenic plaques is another promising principle of molecular imaging. If a reliable protocol to image vulnerable plaques, which are prone to rupture, can be established and introduced into clinical practice, the required measures such as atheroprotective medication or revascularization could be undertaken to prevent serious cardiovascular events. 相似文献
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I. Gonçalves H. den Ruijter M. Nahrendorf G. Pasterkamp 《Journal of internal medicine》2015,278(5):520-530
Atherosclerosis is a systemic condition that eventually evolves into vulnerable plaques and cardiovascular events. Pathology studies reveal that rupture‐prone atherosclerotic plaques have a distinct morphology, namely a thin, inflamed fibrous cap covering a large lipidic and necrotic core. With the fast development of imaging techniques in the last decades, detecting vulnerable plaques thereby identifying individuals at high risk for cardiovascular events has become of major interest. Yet, in current clinical practice, there is no routine use of any vascular imaging modality to assess plaque characteristics as each unique technique has its pros and cons. This review describes the techniques that may evolve into screening tool for the detection of the vulnerable plaque. Finally, it seems that plaque morphology has been changing in the last decades leading to a higher prevalence of ‘stable’ atherosclerotic plaques, possibly due to the implementation of primary prevention strategies or other approaches. Therefore, the nomenclature of vulnerable plaque lesions should be very carefully defined in all studies. 相似文献