高血压患者氯沙坦治疗前后血管内皮功能与血管紧张素Ⅱ的变化

目的探讨氯沙坦治疗前后高血压患者血管内皮功能和血浆血管紧张素Ⅱ的变化.方法50例高血压患者氯沙坦治疗4～6周,根据达目标血压(以舒张压<90mmHg为标准调整降压药每天剂量50～100mg,部分患者加双氢氯噻嗪25mg),观察氯沙坦治疗前后肱动脉超声检测血管内皮功能和血浆血管紧张素Ⅱ浓度的变化.结果肱动脉内径基础值及含服硝酸甘油后肱动脉内径变化差异均无显著性[(3.78±0.57)mm对(3.82±0.63)mm,(18.7±4.5)%对(20.1±7.2)%,P>0.05],反应性血管充血引起肱动脉内径的变化治疗前后差异有显著性[(4.32±0.71)%对(9.38±4.1)%,P<0.01)].氯沙坦治疗前后血浆血管紧张素Ⅱ浓度变化显著[(38.6±6.8)pmol/L对(76.9±15.3)pmol/L,P<0.01].结论氯沙坦在有效降压的同时,能改善血管内皮舒张功能.     

人白细胞介素10对血管紧张素Ⅱ诱导的大鼠血管平滑肌细胞增殖的作用

目的观察重组人白介素10 (rhIL-10) 对血管紧张素Ⅱ(AngⅡ)刺激下离体大鼠胸主动脉血管平滑肌细胞增殖及对p44/p42 丝裂素活化蛋白激酶的影响. 方法体外培养大鼠主动脉血管平滑肌细胞,采用MTS/PES(methoxyphenyl-tetrazolium salt/phenazine ethosulfate)法确定血管平滑肌细胞的增殖状态.利用p44/p42磷酸化抗丝裂素活化蛋白激酶抗体的蛋白免疫印迹法测定丝裂素活化蛋白激酶蛋白的表达;对照组为未用AngⅡ刺激的血管平滑肌细胞. 结果 AngⅡ对大鼠血管平滑肌细胞增殖具有明显的刺激作用(1.311±0.201 对 0.781 ±0.236, P<0.05).rhIL-10单独应用对血管平滑肌细胞生长没有影响(0.783±0.170 对 0.781±0.236, P>0.05).在AngⅡ刺激下,1、10、100 ng/ml的rhIL-10均可抑制血管平滑肌细胞的生长 (分别为0.984±0.172、 0.932±0.134、 0.784±0.097对1.311±0.201, P<0.05).AngⅡ对p44/p42 丝裂素活化蛋白激酶蛋白表达有显著的增强作用(512±78对100,P< 0.01), 此作用可被rhIL-10抑制 (512±78对329±59, P< 0.01). 结论 rhIL-10可抑制AngⅡ诱导的血管平滑肌细胞增殖及p44/p42 丝裂素活化蛋白激酶蛋白的表达.     

卡托普利和缬沙坦对兔动脉粥样硬化斑块中血管紧张素Ⅱ及纤溶酶原激活物抑制剂1表达的影响

目的观察兔动脉粥样硬化斑块局部血管紧张素Ⅱ和纤溶酶原激活物抑制物1的表达水平,并观察卡托普利和缬沙坦对其的影响。方法雄性健康新西兰兔随机分为高脂饮食组、卡托普利组、缬沙坦组和正常对照组。饲养10周后,取动脉血用发色底物法测定血浆纤溶酶原激活物抑制物1活性,放射免疫法测定血浆血管紧张素Ⅱ含量;取主动脉组织作病理形态学观察,免疫组织化学方法观察动脉粥样硬化斑块中血管紧张素Ⅱ及纤溶酶原激活物抑制物1的表达。结果与正常对照组相比,高脂饮食组血浆血管紧张素Ⅱ含量显著增高(494.86±67.98 ng/L比44.21±18.34 ng/L,P<0.01),血浆纤溶酶原激活物抑制物1活性显著提高(9.38±1.55 kAU/L比6.67±0.47 kAU/L,P<0.01),动脉粥样硬化斑块中血管紧张素Ⅱ及纤溶酶原激活物抑制物1阳性表达显著增高(46.97%±14.32%比4.17%±1.01%和48.50%±13.46%比1.33%±0.52%,P<0.01);与高脂饮食组相比,卡托普利组和缬沙坦组血浆纤溶酶原激活物抑制物1活性明显降低(7.23±0.46 kAU/L和7.42±0.59 kAU/L比9.38±1.55 kAU/L,P<0.05),斑块中血管紧张素Ⅱ阳性表达显著降低(26.30%±5.00%和27.83%±7.30%比46.97%±14.32%,P<0.05),斑块中纤溶酶原激活物抑制物1阳性表达显著降低(20.37%±8.23%和22.50%±7.06%比48.50%±13.46%,P<0.05)。斑块中纤溶酶原激活物抑制物1表达与血管紧张素Ⅱ表达呈正相关(r=0.796,P<0.01)。结论在高脂饮食所致动脉粥样硬化斑块中血管紧张素Ⅱ和纤溶酶原激活物抑制物1的表达增加,且二者呈正相关;卡托普利和缬沙坦减轻动脉粥样硬化斑块中血管紧张素Ⅱ和纤溶酶原激活物抑制物1的表达。     

福辛普利对高脂诱发动脉粥样硬化血管内皮细胞黏附分子-1 mRNA表达的影响

目的利用高脂诱发的动脉粥样硬化模型观察了血管紧张素转换酶抑制剂福辛普利(fosinopril)的抗动脉粥样硬化作用.方法将建立动脉粥样硬化模型日本大耳白兔32只,随机分为三组对照组8只;高胆固醇组11只;福辛普利组13只.检测如下指标⑴计算主动脉粥样斑块面积.⑵测定血浆脂蛋白水平及低密度脂蛋白(LDL)氧化易感性.⑶RT-PCR检测组织中血管内皮细胞黏附分子(VCAM-1) mRNA表达的水平.结果福辛普利组和高脂组与对照组相比总胆固醇和甘油三酯水平明显升高,但二组间差异无显著性(P>0.05).福辛普利组动脉粥样斑块面积明显低于高胆固醇组[(26±5.4)% 比 (41±9.6)%,P<0.05]; 与高脂组比较福辛普利明显延长CuSO4诱导的LDL脂蛋白氧化反应的潜伏期(150 min 与240 min,P<0.001).福辛普利组主动脉VCAM-1/GAPDH mRNA比值低于高胆固醇组(0.90±0.35和1.40±0.51,P<0.05).福辛普利组明显降低了主动脉组织中VCAM-1的mRNA的表达.结论血管紧张素转换酶抑制剂福辛普利通过抑制低密度脂蛋白的氧化及黏附分子VCAM-1的表达延缓早期的动脉粥样硬化病变.     

高甘油三酯血症对血管内皮功能的影响

目的观察高甘油三酯血症对血管内皮功能的影响.方法对30例高甘油三酯血症患者和30例正常人,采用高分辨超声技术检测血流介导的和硝酸甘油介导的肱动脉舒张功能,并测定血浆内皮素和血脂.结果 1.高甘油三酯血症组血流介导的肱动脉舒张较正常组明显减弱[分别为(2.7±2.0)%和(15.0±8.0)%,P<0.001],而两组对硝酸甘油的血管舒张反应无显著性差异[分别为(15.0±5.0)%和(16.8±9.0)%,P>0.05].2.高甘油三酯血症组血浆内皮素水平显著高于正常组[分别为(106.22±19.16)μg/L和(72.37±14.06)μg/L,P<0.001].结论高甘油三酯血症患者内皮依赖性血管舒张功能明显受损.血管内皮功能失调可能是高甘油三酯血症致动脉粥样硬化的一个重要机制.     

血管紧张素Ⅱ和卡托普利、缬沙坦对人脐静脉内皮细胞PAI-1、tPA蛋白表达的影响

目的研究血管紧张素Ⅱ(Ang Ⅱ)和血管紧张素转换酶抑制剂(ACEI),卡托普利和Ang Ⅱ 1型受体(AT-1)拮抗剂缬沙坦对人脐静脉内皮细胞(HUVECs)1型纤溶酶原激活物抑制剂(PAI-1)、组织型纤溶酶原激活剂(tPA)蛋白的释放及活性的影响.方法将不同浓度的Ang Ⅱ(10-6～10-9 mol/L)与HUVECs共同孵育24 h,以及将10-6 mol/L的Ang Ⅱ与HUVECs作用不同时间(0、4、8、12、24 h)后,用细胞酶联免疫法和发色底物法分别检测细胞培养液中PAI-1、tPA的含量及活性,并观察卡托普利和缬沙坦干预后的影响.结果 10-6mol/L Ang Ⅱ作用HUVECs 24 h后,可使细胞分泌的PAI-1含量与对照组相比明显增高(280±15.60 vs 83.33±10.56) ng/mL,P<0.01),PAI-1活性明显增加(9.25±0.39 vs 7.53±0.33) IU/mL,P<0.01),Ang Ⅱ虽也可刺激tPA含量增加(101.67±3.78 vs 70±5.62) ng/mL,(P<0.01),但PAI-1的增量是tPA增量的6～7倍(Δ196.67±21.34 vs Δ31±6.50) ng/mL,(P<0.01),Ang Ⅱ对tPA活性无影响(0.97±0.05 vs 0.95±0.08) ng/mL,(P>0.05);缬沙坦可显著抑制Ang Ⅱ的促PAI-1分泌作用(212.67±5.38 vs 290±6.57) IU/mL,(P<0.01),而卡托普利对Ang Ⅱ的促PAI-1分泌作用无明显抑制作用(278.33±9.16 vs 290±6.57) IU/mL,(P>0.05).结论 Ang Ⅱ可促使HUVECs分泌PAI-1,并使其活性增加;Ang Ⅱ亦可刺激tPA分泌,但作用弱于PAI-1,对其活性无明显影响.缬沙坦可抑制Ang Ⅱ促HUVECs分泌PAI-1的作用;卡托普利的作用不显著.     

多沙唑嗪对高血压患者动态血管平滑肌细胞NO产生的影响

采用高血压患者的肠系膜动脉进行分离培养,检测细胞培养液中的NO含量.结果多沙唑嗪治疗组的NO含量高于对照组(74.56±4.56μmol/L,42.77±6.76μmol/L,P<0.05).认为多沙唑嗪增加了高血压患者动脉血管平滑肌细胞NO的产生.     

福辛普利和氯沙坦对SHR血管紧张素Ⅱ受体1基因表达的影响

目的研究福辛普利和氯沙坦对自发性高血压大鼠(SHR)血管紧张素Ⅱ受体1(AT1-R)的基因表达水平及心血管细胞增殖的影响,探讨高血压病的病理机制.方法 48只10周龄SHR随机分3组,1组服福辛普利5 mg*kg-1*d-1;2组服氯沙坦20 mg*kg-1*d-1;3组(对照组) 服安慰剂.3组分别灌胃持续9 周,实验前及实验中每2周测尾动脉血压,9周后,抽血并处死动物取材,放免法测血管紧张素Ⅱ(Ang Ⅱ),用半定量RT-PCR 测量心肌AT1-R的 mRNA水平,光、电镜观察心肌及主动脉组织学改变. 结果血压对照组随增龄上升,两治疗组实验第2周起各次均较治疗前低,差异多具显著性,实验第8周福辛普利组为(165.1±4.9)mmHg、氯沙坦组为(156.3±4.2)mmHg,均较对照组(179.1±10.4)mmHg低,差异显著,P<0.01.血浆Ang Ⅱ浓度对照组为(440.0±190.3)pg/mL,福辛普利组为(566.0±149.3)pg/mL和氯沙坦组(529.3±200.9)pg/mL均较对照组高,但均无显著性差异,P>0.05.心肌AT1-R的mRNA水平福辛普利组为(72.0±35.0)%,对照组为(102.4±21.9)%,显著高于前者,P<0.05;氯沙坦组为(101.9±27.3)%,与对照组差异无显著性,P>0.05,但较福辛普利组高,差异显著,P<0.05;AT1-R的mRNA水平与治疗后血压不相关,与对照组Ang Ⅱ浓度正相关,r=0.596,P<0.05,而与两治疗组无相关性;心血管病变光、电镜下两治疗组心血管细胞增殖明显减轻,氯沙坦组减轻更显著. 结论福辛普利可下调SHR心肌AT1-R基因表达水平,氯沙坦则对其无影响;福辛普利和氯沙坦均可抑制SHR心血管细胞增殖,但不伴有Ang Ⅱ浓度的显著性改变.     

缬沙坦对腹主动脉缩窄大鼠心血管重构的影响

目的观察血管紧张素Ⅱ1型受体拮抗剂缬沙坦对腹主动脉缩窄(AAC)大鼠心血管重构的影响。方法用AAC法建立动物模型,将32只雄性SD大鼠随机分成4组:假手术组,AAC对照组,AAC低剂量缬沙坦组(1mg·kg-1·d-1),AAC高剂量缬沙坦组(30mg·kg-1·d-1),每组8只。药物经灌胃6周后通过颈动脉测定收缩压,同时测定左心室重量指数。用图像分析仪检测出主动脉和肠系膜上动脉中膜厚度/管腔内径比值。用放射免疫法测定血浆及心血管中的血管紧张素Ⅱ、醛固酮。结果无显著降压作用的低剂量缬沙坦能抑制主动脉、肠系膜上动脉中膜肥厚及左心室肥厚,但明显降低血压的高剂量作用更显著,AAC高剂量缬沙坦组上述各项参数与假手术组无显著性差异。结论缬沙坦能抑制AAC大鼠心血管重构,其可能机制是与抑制了心血管局部肾素-血管紧张素-醛固酮系统的活性有关。     

血管紧张素受体与心肌胶原代谢关系的研究

目的研究血管紧张素Ⅱ受体在心肌胶原代谢中的作用。方法应用放射免疫结合分析、生化测定、病理检查结合计算机分析等方法检测大鼠腹主动脉缩窄后10周,左室心肌胶原形态、胶原溶积分数（CVF）、血管周围胶原面积(PVCA)、胶原浓度（HC）、Ⅰ、Ⅲ型胶原比值（Ⅰ/Ⅲ）以及血管紧张素Ⅱ含量（AngⅡ）和血管紧张素Ⅱ受体的最大结合量（Bmax）。结果手术组左室心肌CVF、PVCA、HC、Ⅰ/Ⅲ、AngⅡ和Bmax均显著高于假手术对照组(P<0.05,P<0.01),心肌胶原异常堆积。AngⅡ含量与心肌胶原浓度（HC）呈显著正相关（r1=0.9045,P<0.01）。Irbesartan治疗后,上述参数可显著降低(P<0.05,P<0.01),异常堆积的胶原消失。CGP42112A可明显降低血管紧张素Ⅱ受体的Bmax（P<0.01）,而CVF、PVCA、HC、Ⅰ/Ⅲ、AngⅡ与手术组无显著差异（P>0.05）。结论压力超负荷时,大鼠心肌胶原增生,间质网络发生重建,心脏局部产生的AngⅡ参与了这一病理生理过程,并主要通过血管紧张素Ⅱ的1型受体（ATR1）来发挥作用。     

外膜炎症诱发载脂蛋白E基因敲除鼠冠状动脉粥样硬化病灶

研究载脂蛋白E基因敲除(载脂蛋白E°)小鼠冠状动脉内粥样硬化病灶的分布、组成与动脉外膜炎症的关系.取载脂蛋白E°小鼠心脏作连续切片,Movat法染色,追踪冠状动脉主干及其心肌内的小分支;寻找病灶,观察病灶内组成,分析其分布规律.复制小鼠股动脉外膜无菌性炎症模型,用免疫组织化学方法检查内膜粘附分子的表达.结果发现,冠状动脉主干内有延伸病灶,在主干以下分支(包括心肌内小分支)内有在原位生成的病灶,在两类病灶相邻的外膜有炎性细胞浸润,外膜炎症面积大于动脉粥样硬化病灶累及的内膜面积,亦发现一些部位血管外有炎性细胞浸润,而尚无病灶形成.原位病灶均发生于心室壁,大的原位病灶多发生在左室壁心肌内、血管分支处和乳头肌附近的冠状动脉分支内.股动脉外膜炎症可诱发内膜表达细胞间粘附分子1和血管细胞粘附分子1,同时伴白细胞的附壁.以上提示血管外膜炎症是小鼠冠状动脉内病灶的一个始动环节.     

Localisation of mRNA for JE/MCP-1 and its receptor CCR2 in atherosclerotic lesions of the ApoE knockout mouse

MCP-1 has potent chemotactic activity for monocytes and is strongly implicated in the pathogenesis of atherosclerosis. In the present study, we have used in situ hybridisation to examine the gene expression of JE, the murine homologue of MCP-1, and its receptor, CCR2, during the development of atherosclerotic lesions in the ApoE knockout mouse. Interestingly, the earliest expression of JE detected during lesion development was found to be localised in mesenchymal cells in the adventitia and not in the intima. Macrophages were subsequently found to accumulate in these affected regions of the adventitia and these cells were found to express high levels of JE. At this stage, early macrophage-rich lesions with high expression of JE were also seen in the intima, but expression of mRNA for the receptor for JE (CCR2) was only found on adventitial macrophages and not in the intima. This sequence of events suggests that adventitial inflammation may be an important early event in lesion development and responsible for the subsequent accumulation of macrophages in the intima possibly by recruitment from the adventitia as well as via the vessel lumen.     

载脂蛋白E基因敲除小鼠动脉粥样硬化早期血管外膜血管细胞黏附分子1和细胞间黏附分子1的表达

目的探讨血管外膜血管细胞黏附分子1和细胞间黏附分子1在动脉粥样硬化病灶形成及发展中的作用。方法 6周龄载脂蛋白E基因敲除小鼠和野生型C57BL/6小鼠,高脂饮食喂养2、4和8周,选取升主动脉制备连续切片,部分切片行Movat染色,观察组织形态学变化并测量外膜厚度的变化;部分切片用免疫组织化学法观察不同阶段血管外膜及内膜血管细胞黏附分子1和细胞间黏附分子1表达的动态变化。结果 6周龄载脂蛋白E基因敲除小鼠和各个时间点的C57BL/6小鼠均未观察到内膜损伤的任何迹象,主动脉外膜厚度亦无显著变化,外膜均无血管细胞黏附分子1的表达;高脂喂养2周后,载脂蛋白E基因敲除小鼠血管外膜厚度增加,但在内膜仍无肉眼可见病灶,此时外膜血管细胞黏附分子1呈现弱阳性表达;高脂喂养4周和8周后,载脂蛋白E基因敲除小鼠血管外膜厚度逐渐增加,内膜出现泡沫细胞,纤维斑块,外膜及内膜损伤处血管细胞黏附分子1表达增强。载脂蛋白E基因敲除小鼠随着高脂喂养时间延长,主动脉外膜及内膜细胞间黏附分子1的表达也增加,但C57BL/6小鼠血管外膜细胞间黏附分子1表达量少且稳定,各时间点之间无明显差异。结论载脂蛋白E基因敲除小鼠随着高脂喂养时间延长血管外膜血管细胞黏附分子1和细胞间黏附分子1的表达增加。     

Interleukin-1 plays a major role in vascular inflammation and atherosclerosis in male apolipoprotein E-knockout mice

OBJECTIVE: To examine the role of the balance between interleukin (IL)-1 and IL-1 receptor antagonist (IL-1Ra) in atherosclerosis and vascular inflammation. METHODS: Transgenic (Tg) mice overexpressing either secreted IL-1Ra or intracellular IL-1Ra1 as well as IL-1Ra-deficient mice (IL-1Ra -/-) were crossed with apolipoprotein E-deficient mice (ApoE -/-). RESULTS: In males fed a cholesterol-rich diet for 10 weeks, average atherosclerotic lesion area within aortic roots was significantly decreased in ApoE -/- secreted IL-1Ra Tg (-47%) and ApoE -/- intracellular IL-1Ra1 Tg (-40%) mice as compared to ApoE -/- non-Tg controls. The extent of sudanophilic lesions was reduced within the thoraco-abdominal aorta in ApoE -/- secreted IL-1Ra (-53%) and ApoE -/- intracellular IL-1Ra1 (-67%) Tg mice. In parallel experiments, we observed early mortality and illness among double deficient mice, whereas ApoE -/- IL-1Ra +/+ and ApoE +/+ IL-1Ra -/- mice were apparently healthy. After 7 weeks of diet, ApoE -/- IL-1Ra -/- mice exhibited massive aortic inflammation with destruction of the vascular architecture, but no signs of atherosclerosis. ApoE -/- IL-1Ra +/+ had atherosclerosis and a moderate inflammatory reaction, whereas ApoE +/+ IL-1Ra -/- mice were free of vascular lesions. Macrophages were present in large amounts within inflammatory lesions in the adventitia of ApoE -/- IL-1Ra -/- mice. CONCLUSION: Our results demonstrate that the IL-1/IL-1Ra ratio plays a critical role in the pathogenic mechanisms leading to vascular inflammation and atherosclerosis in ApoE -/- mice.     

Lymphangiogenesis promotes inflammation and neointimal hyperplasia after adventitia removal in the rat carotid artery

Lymphatic vessels exist in adventitia in the atherosclerotic coronary artery and play an important role in the inflammatory and immune response. After adventitia removal, the carotid wall of rat model showed significantly increased ratio of intimal to medial area (I/M ratio), the number of adventitial lymphatic vessels (Ad-LV) and microvessels (Ad-MV), and macrophage index and expression of VEGF-C, VEGFR-3, PDGF-B and PDGFR-beta. The I/M ratio was significantly correlated with Ad-LV and macrophage index but not Ad-MV. These results suggest that adventitial lymphangiogenesis is stimulated by growth factors released by inflammatory cells in vasculature after adventitia removal, and these neogenetic lymph vessels in turn promote intimal inflammation and hyperplasia, probably via delivery and activation of inflammatory cells.     

EMAP-II downregulation contributes to the beneficial effects of rapamycin after vascular injury

AIMS: Neointima formation after vascular injury is strongly associated with inflammation. Rapamycin inhibits human neointima formation and reduces expression of the proinflammatory cytokine endothelial-monocyte activating peptide II (EMAP-II) in vitro. Here we investigated the interplay between EMAP-II and rapamycin after vascular injury in vivo. METHODS AND RESULTS: In a mouse model of vascular injury, mice were either not treated, given everolimus, a rapamycin derivate, or subjected to simultaneous challenge with everolimus and EMAP-II. EMAP-II expression was measured in coronary artery smooth muscle cells (CASMC) and monocytic cells in vitro and in patients after percutaneous coronary intervention (PCI). After vascular injury, rapamycin reduced neointima formation and adventitial thickening. Immunohistochemistry revealed reduced EMAP-II protein expression and suppressed recruitment of inflammatory cells. Simultaneous challenge with EMAP-II counteracted these effects of rapamycin. Expression of EMAP-II and its inhibition by rapamycin was confirmed in CASMC and monocytic cells. In patients, EMAP-II upregulation was confined to PCI of distal coronary artery segments and profoundly suppressed by oral rapamycin treatment. CONCLUSION: These data suggest important yet unrecognized roles of EMAP-II and adventitial inflammation in neointima formation: Through inhibition of EMAP-II, rapamycin reduces the recruitment of inflammatory cells to the adventitia and supports an early and bland healing.     

普伐他汀和辛伐他汀对载脂蛋白E缺陷小鼠主动脉粥样硬化形成及主动脉壁血管细胞粘附分子-1表达的影响

为观察普伐他汀和辛伐他汀对载脂蛋白E缺陷小鼠主动脉粥样斑块形成的影响及主动脉壁血管细胞粘附分子 1表达的影响 ,将载脂蛋白E缺陷小鼠分为普伐他汀组 (每天 10mg/kg)、辛伐他汀组 (每天 5mg/kg)和阳性对照组 (等量生理盐水 ) ,从主动脉血管根部连续切片 ,常规HE染色 ,计算机图像扫描 ,分析主动脉粥样硬化斑块的面积和斑块占管腔面积等 ;采用免疫组织化学及Western杂交方法测定主动脉壁血管细胞粘附分子 1表达。结果发现 ,除降胆固醇作用外 ,普伐他汀和辛伐他汀皆延缓斑块形成 ,与对照载脂蛋白E缺陷小鼠比 ,用药组小鼠的主动脉粥样斑块明显缩小 ;普伐他汀和辛伐他汀还明显抑制载脂蛋白E缺陷小鼠主动脉壁血管细胞粘附分子 1的表达 ;其中 2药对 14和 2 4周龄小鼠主动脉壁血管细胞粘附分子 1表达的抑制作用强于 34周龄小鼠。结果提示 ,普伐他汀和辛伐他汀可延缓或缩小载脂蛋白E缺陷小鼠主动脉粥样斑块的形成 ,抑制或下调主动脉壁血管细胞粘附分子 1表达 ,其效果与降胆固醇作用不成比例 ,可能是独立于调脂作用以外的抗动脉粥样硬化机制     

The role of the adventitia in vascular inflammation

Traditional concepts of vascular inflammation are considered "inside-out" responses centered on the monocyte adhesion and lipid oxidation hypotheses. These mechanisms likely operate in concert, holding the central tenet that the inflammatory response is initiated at the luminal surface. However, growing evidence supports a new paradigm of an "outside-in" hypothesis, in which vascular inflammation is initiated in the adventitia and progresses inward toward the intima. Hallmarks of the outside-in hypothesis include population of the adventitia with exogenous cell types, including monocytes, macrophages, and lymphocytes, the phenotypic switch of adventitial fibroblasts into migratory myofibroblasts, and increased vasa vasorum neovascularization. The resident and migrating cells deposit collagen and matrix components, respond to and upregulate inflammatory chemokines and/or antigens, and regulate the local redox state of the adventitia. B cells and T cells generate local humoral immune responses against local antigen presentation by foam cells and antigen presenting cells. These events result in increased local expression of cytokines and growth factors, evoking an inflammatory response that propagates inward toward the intima. Ultimately, it appears that the basic mechanisms of cellular activation and migration in vascular inflammation are highly conserved across a variety of cardiovascular disease states and that major inflammatory events begin in the adventitia.     

Significance of adventitial inflammation of the coronary artery in patients with unstable angina: results at autopsy

A quantitative analysis of adventitial inflammation of the coronary artery with intimal lesions is described in 12 patients who suffered coronary death and had had unstable angina (crescendo angina) at rest (group 1). After autopsy in these patients we examined epon-embedded cross sections by light and electron microscopy, paying particular attention to the adventitia, and compared these results with those in six patients who had had angina but died of noncardiac causes (group 2) and those in 22 patients who did not have angina (group 3). Of the 132 segments from group 1 patients, 39 (30%) were narrowed 76% to 100% by atherosclerotic plaque (group 2, 27%; group 3, 1%), and 23 (17%) had occlusive thrombi. Of the 264 sections (two from each segment) from group 1 that were examined, 98 (37%) (group 2, 15%; group 3, 9%) revealed clustered infiltration of inflammatory cells in the adventitia, half of which were associated with vascular nerve involvement. These findings in the adventitia may be related to the vasospastic component of unstable angina.     

Coronary artery lesions in Takayasu arteritis: Pathological considerations

This communication reviews the clinical and pathological features of coronary artery lesions in Takayasu arteritis. The incidence of coronary artery involvement has been reported to be 9% to 10%, and is observed mainly in autopsy cases because coronary artery disease is usually not evident until the occurrence of angina pectoris or myocardial infarction, or after the onset of congestive heart failure. On the basis of pathological features, the following three types of coronary artery lesions can be distinguished: type 1, stenosis or occlusion of the coronary ostia and the proximal segments of the coronary arteries; type 2, diffuse or focal coronary arteritis, which may extend diffusely to all epicardial branches or may involve focal segments, so-called skip lesions; and type 3, coronary aneurysm. Most of the coronary artery lesions in Takayasu arteritis are of type 1. Narrowing of the coronary arteries is mainly due to the extension of the inflammatory processes of proliferation of the intima and contraction of the fibrotic media and adventitia from the ascending aorta. In some cases, coronary stenosis may be caused by coronary arteritis as skip lesions in Takayasu arteritis, but even in these cases the lesions have been reported to affect mainly the proximal segments of the coronary arteries. Diffuse lesions of the coronary artery and coronary artery aneurysm seem to be very rare in Takayasu arteritis. Other causes of coronary ostial stenosis, coronary arteritis and coronary artery aneurysm are also discussed.