张林娜,侯静波

• 1:哈尔滨医科大学附属第二医院心内科
• 2:心肌缺血省部共建教育部重点实验室

摘要(Abstract)：

<正>冠状动脉内血栓形成是导致急性冠状动脉综合征(ACS)最常见的原因。而导致血栓形成的最常见机制为斑块破裂(PR)、斑块侵蚀和钙化结节(CN)[1-3]。对心脏性猝死(SCD)的患者进行尸检发现,PR最常见[1,4],破裂倾向的斑块有几种组织学特征:(1)薄纤维帽(<65μm);(2)大的脂质池;(3)纤维帽附近巨噬细胞聚集[4-5]。同时也发现,很大一部分血栓形成的病变与潜在的斑块破裂并没有什么关系。van der Wal等[6]发现在20例SCD患者中有60%发

关键词(KeyWords)： 斑块侵蚀;钙化结节;斑块破裂;急性冠状动脉综合征

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 张林娜,侯静波

参考文献(References)：

• [1]Virmani R,Kolodgie FD,Burke AP,et al.Lessons from sudden coronary death:a comprehensive morphological classification scheme for atherosclerotic lesions.Arterioscler Thromb Vasc Biol,2000,20:1262-1275.
• [2]Naghavi M,Libby P,Falk E,et al.From vulnerable plaque to vulnerable patient:a call for new definitions and risk assessment strategies:part I.Circulation,2003,108:1664-1672.
• [3]Giugliano R,Braunwald E.The year in acute coronary syndrome.J Am Coll Cardiol,2014,63:201-214.
• [4]Virmani R,Burke AP,Farb A,et al.Pathology of the vulnerable plaque.J Am Coll Cardiol,2006,47:C13-C18.
• [5]Kolodgie FD,Virmani R,Burke AP,et al.Pathologic assessment of the vulnerable human coronary plaque.Heart,2004,90:1385-1391.
• [6]van der Wal AC,Becker AE,van der Loos,et al.Site of intimal rupture or erosion of thrombosed coronary atherosclerotic plaques is characterized by an inflammatory process irrespective of the dominant plaque morphology.Circulation,1994,89:36-44.
• [7]Farb A,Burke AP,Tang AL,et al.Coronary plaque erosion without rupture into a lipid core.A frequent cause of coronary thrombosis in sudden coronary death.Circulation,1996,93:1354-1363.
• [8]Jia H,Abtahian F,Aguirre AD,et al.In vivo diagnosis of plaque erosion and calcified nodule in patients with acute coronary syndrome by intravascular optical coherence tomography.J Am Coll Cardiol,2013,62:1748-1758.
• [9]Burke AP,Farb A,Malcom GT,et al.Effect of risk factors on the mechanism of acute thrombosis and sudden coronary death in women.Circulation,1998,2,97:2110-2116.
• [10]Xu Y,Mintz GS,Tam A,et al.Prevalence,distribution,predictors,and outcomes of patients with calcifi ed nodules in native coronary arteries:a 3-vessel intravascular ultrasound analysis from Providing Regional Observations to Study Predictors of Events in the Coronary Tree(PROSPECT).Circulation,2012,126:537-545.
• [11]Budoff MJ,Rader DJ,Reilly MP,et al.Relationship of estimated GFR and coronary artery calcifi cation in the CRIC(Chronic Renal Insuffi ciency Cohort)Study.Am J Kidney Dis,2011,58:519-526.
• [12]Sakakura K,Nakano M,Otsuka F,et al.Pathophysiology of atherosclerosis plaque progression.Heart Lung Circ,2013,22:399-411.
• [13]Kolodgie FD,Burke AP,Farb A,et al.Differential accumulation of proteoglycans and hyaluronan in culprit lesions:insights into plaque erosion.Arterioscler Thromb Vasc Biol,2002,22:1642-1648.
• [14]Kramer MC,Rittersma SZ,de Winter RJ,et al.Relationship of thrombus healing to underlying plaque morphology in sudden coronary death.J Am Coll Cardiol,2010,55:122-132.
• [15]Ferrante G,Nakano M,Prati F,et al.High levels of systemic myeloperoxidase are associated with coronary plaque erosion in patients with acute coronary syndromes:a clinicopathological study.Circulation,2010,122:2505-2513.
• [16]Libby,P.Mechanisms of acute coronary syndromes and their implications for therapy.N Engl J Med,2013,368:2004-2013.
• [17]Burke AP,Weber DK,Kolodgie FD,et al.Pathophysiology of calcium deposition in coronary arteries.Herz.2001,26:239-244.
• [18]于波.光学相干断层成像与冠状动脉粥样硬化.中国介入心脏病学杂志,2013,21:387-389.
• [19]Kubo T,Imanishi T,Takarada S,et al.Assessment of culprit lesion morphology in acute myocardial infarction:ability of optical coherence tomography compared with intravascular ultrasound and coronary angioscopy.J Am Coll Cardiol,2007,50:933-939.
• [20]Rathore S,Terashima M,Matsuo H,et al.Association of coronary plaque composition and arterial remodelling:a optical coherence tomography study.Atherosclerosis,2012,221:405-415.
• [21]刘峰,王炳银.冠状动脉易损斑块的研究进展.中国介入心脏病学杂志,2012,20:171-174.