Virmani Renu, Burke Allen P, Farb Andrew, Kolodgie Frank D
CVPath, International Registry of Pathology, Gaithersburg, Maryland 20878, USA.
J Am Coll Cardiol. 2006 Apr 18;47(8 Suppl):C13-8. doi: 10.1016/j.jacc.2005.10.065.
The majority of patients with acute coronary syndromes (ACS) present with unstable angina, acute myocardial infarction, and sudden coronary death. The most common cause of coronary thrombosis is plaque rupture followed by plaque erosion, whereas calcified nodule is infrequent. If advances in coronary disease are to occur, it is important to recognize the precursor lesion of ACS. Of the three types of coronary thrombosis, a precursor lesion for acute rupture has been postulated. The non-thrombosed lesion that most resembles the acute plaque rupture is the thin cap fibroatheroma (TCFA), which is characterized by a necrotic core with an overlying fibrous cap measuring <65 microm, containing rare smooth muscle cells but numerous macrophages. Thin cap fibroatheromas are most frequently observed in patients dying with acute myocardial infarction and least common in plaque erosion. They are most frequently observed in proximal coronary arteries, followed by mid and distal major coronary arteries. Vessels demonstrating TCFA do not usually show severe narrowing but show positive remodeling. In TCFAs the necrotic core length is approximately 2 to 17 mm (mean 8 mm) and the underlying cross-sectional area narrowing in over 75% of cases is <75% (diameter stenosis <50%). The area of the necrotic core in at least 75% of cases is < or =3 mm2. These lesions have lesser degree of calcification than plaque ruptures. Thin cap fibroatheromas are common in patients with high total cholesterol (TC) and high TC/high-density lipoprotein cholesterol ratio, in women >50 years, and in those patients with elevated high levels of high sensitivity C-reactive protein. It has only recently been recognized that their identification in living patients might help reduce the incidence of sudden coronary death.
大多数急性冠状动脉综合征（ACS）患者表现为不稳定型心绞痛、急性心肌梗死和心源性猝死。冠状动脉血栓形成的最常见原因是斑块破裂，其次是斑块侵蚀，而钙化结节则较少见。如果要在冠心病研究方面取得进展，识别ACS的前驱病变很重要。在三种类型的冠状动脉血栓形成中，已推测出急性破裂的前驱病变。最类似于急性斑块破裂的非血栓性病变是薄纤维帽粥样瘤（TCFA），其特征是坏死核心上方覆盖着厚度小于65微米的纤维帽，含有稀少的平滑肌细胞但有大量巨噬细胞。薄纤维帽粥样瘤最常见于死于急性心肌梗死的患者，在斑块侵蚀患者中最不常见。它们最常出现在冠状动脉近端，其次是冠状动脉主干的中段和远端。显示TCFA的血管通常不会出现严重狭窄，但会出现正向重塑。在TCFA中，坏死核心长度约为2至17毫米（平均8毫米），超过75%的病例中其下方的横截面积狭窄小于75%（直径狭窄小于50%）。至少75%的病例中坏死核心面积小于或等于3平方毫米。这些病变的钙化程度低于斑块破裂。薄纤维帽粥样瘤在总胆固醇（TC）高、TC/高密度脂蛋白胆固醇比值高的患者、50岁以上女性以及高敏C反应蛋白水平升高的患者中很常见。直到最近才认识到，在活体患者中识别它们可能有助于降低心源性猝死的发生率。
