他汀对不稳定斑块的作用-张沛

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1、他汀对不稳定斑块的作用阜外心血管病医院张沛TCC2009CRP=C反应蛋白；;LDL-C=低密度脂蛋白胆固醇.LibbyP.Circulation.2001;104:365-372;RossR.NEnglJMed.1999;340:115-126.单核细胞LDL-C黏附分子巨噬细胞泡沫细胞氧化的LDL-C斑块破裂平滑肌细胞CRP斑块不稳定和血栓形成斑块形成炎症/氧化内皮功能受损“LDL-C→斑块→事件”链动脉粥样硬化性疾病的共同发病机制事件动脉粥样硬化的主要分型I动脉粥样硬化的主要分型IIAtherosclerosisandtheArterialWallFromSt

2、aryHC.AtlasofAtherosclerosis:ProgressionandRegression.2nded.NewYork:ParthenonPublishing;2003,usedwithpermission.InsullWJr.AmJMed.2009;122:S3S14.LumenLipid-RichNecroticCoreFibrousCapAtheromaNormalMediaAdventitiaIntimaDevelopmentalPathologyofArterialLesionsThinfibrouscapatheroma.FromVirm

3、aniRetal.ArteriosclerThrombVascBiol.2000;20:1262-1275;usedwithpermission.Healedplaquerupture.FromStaryHC.AtlasofAtherosclerosis:ProgressionandRegression.2nded.NewYork:ParthenonPublishing;2003;usedwithpermission.Stenosis(crosssectionofanteriordescendingcoronaryartery).FromStaryHC.Atlasof

4、Atherosclerosis:ProgressionandRegression.2nded.NewYork:ParthenonPublishing;2003;usedwithpermission.ThinfibrouscapLipid-richnecroticcoreSeeFigure3fordevelopmentalflowchart.OlderfibrouscapNewerfibrouscapInsullWJr.AmJMed.2009;122:S3S14.IncreasingExtentofAtheroscleroticPlaquesWithAgeCVD=ca

5、rdiovasculardisease;LAD=leftanteriordescendingcoronaryartery.AdaptedwithpermissionfromMcGillHCJr(ed).LabInvest.1968;18:465–653.InsullWJr.AmJMed.2009;122:S3S14.AgeGroup(Years)MeanPercentIntimalSurfaceInvolvedWithLesionsAtherosclerosisinLADWhiteMalesNewOrleansHighRiskofCVDAtherosclero

6、sisinLADWhiteMalesSantiago,ChileLowRiskofCVDAgeGroup(Years)导致急性冠脉综合症的主要粥样斑块类型Ruptureofthethincapfibrousatheroma(TCFA)ErosionoftheendotheliumProtrusionofacalcifiednoduleintothearteriallumenAdvancedstenosisoffibrocalcificplaqueDevelopmentalPathologyofAtherosclerosisACS=acutecoronarysyn

7、dromes.AdaptedwithpermissionfromVirmaniRetal.ArteriosclerThrombVascBiol.2000;20:1262–1275.InsullWJr.AmJMed.2009;122:S3S14.AdaptedfromRosensenRS.ExpOpinEmergDrugs2004;9(2):269-279LaRosaJCetal.NEnglJMed2005;352:1425-1435他汀类药物试验中，LDL-C治疗和冠心病密切相关-低些好些治疗后的LDL-C水平mg/dL(mmol/L)WOSCOP