Atherothrombosis Research Unit, Mount Sinai Hospital, New York, NY, USA.
Intern Emerg Med. 2011 Feb;6(1):29-34. doi: 10.1007/s11739-010-0423-4. Epub 2010 Jul 7.
The term "vulnerable plaque" identifies atherosclerotic lesions prone to rupture. Plaque disruption facilitates the interaction of the inner components of the lesion, tissue factor (TF) among them, with the flowing blood. This results in activation of the coagulation cascade, ultimately leading to thrombus formation, and abrupt vascular occlusion. Despite the central role of vulnerable plaques in the onset of acute coronary syndromes (ACS), there are certain conditions (e.g., eroded plaques) where a hyperactive, "vulnerable" blood, may play a predominant pathophysiological role. Recently, two distinct pools of circulating TF have been identified. One, associated with cell-derived microparticles probably originating from apoptotic cells, such as macrophages, smooth muscle cells, and endothelium. The most recent, blood-borne TF, circulates in an "inactive" form (encryption) and has to be activated (decryption) to exert its thrombogenic activity. Certain pathological conditions associated with an increased rate of thrombotic complications have been associated with high levels of circulating TF. It is thought that the blood-borne TF perpetuates the initial thrombogenic stimulus, leading to the formation of larger or more stable thrombus, and thus, more severe ACS. Thus, the concept of vulnerable blood could represent a new link between the vulnerable lesion and the high-risk patient. Therefore, the assessment of selected biomarkers associated with "vulnerable or hyperreactive blood", e.g., blood-borne tissue factor, may represent a useful tool to identify patients with a high-risk profile of developing major cardiovascular events.
“易损斑块”一词指的是易于破裂的动脉粥样硬化斑块。斑块破裂使病变的内部成分（包括组织因子 TF）与流动的血液相互作用。这导致凝血级联反应的激活，最终导致血栓形成和血管突然阻塞。尽管易损斑块在急性冠脉综合征（ACS）的发病中起着核心作用，但在某些情况下（如侵蚀性斑块），活性过高的“易损”血液可能发挥主要的病理生理作用。最近，已经确定了两种不同的循环 TF 池。一种与源自细胞的细胞衍生微粒体（如巨噬细胞、平滑肌细胞和内皮细胞）相关。最新的血液来源 TF 以“非活性”形式（加密）循环，必须被激活（解密）才能发挥其促血栓形成活性。某些与血栓形成并发症发生率增加相关的病理状况与循环 TF 水平升高有关。人们认为，血液来源的 TF 使最初的促血栓形成刺激持续存在，导致形成更大或更稳定的血栓，从而导致更严重的 ACS。因此，易损血液的概念可能代表易损病变与高危患者之间的新联系。因此，评估与“易损或高反应性血液”相关的选定生物标志物，如血液来源的组织因子，可能是识别发生主要心血管事件风险较高的患者的有用工具。
