Institute for Clinical Research and Health Policy Studies, Tufts University School of Medicine, Boston, MA, USA.
Ann Intern Med. 2010 Sep 21;153(6):387-95. doi: 10.7326/0003-4819-153-6-201009210-00272. Epub 2010 Aug 16.
The scope of recent literature on the concept of "vulnerable plaque" was reviewed by examining 463 abstracts of primary and review articles identified through MEDLINE (2003 to April 2010). Proposed definition criteria of vulnerable plaque included active inflammation, a thin cap with a large lipid core, endothelial denudation, fissured cap, severe stenosis, or combinations of these findings. In 242 primary studies, histopathology, biomarkers, and imaging of carotid and coronary artery plaques were evaluated for features suggestive of vulnerability. Notably, 89% of these studies were cross-sectional in design and were exclusively conducted in patients with known cardiovascular disease. None of the imaging studies documented whether the identified lesions were responsible for cardiovascular events. Cross-sectional design precludes evaluation of the predictive utility of biomarkers. Because vulnerable plaque is not an established medical diagnosis, no studies have been done that explicitly evaluate the treatment of vulnerable plaques. Few studies examined potential systemic treatments (for example, statins) to modify vulnerability features. Large prospective studies in patients with and without previous cardiovascular events during long follow-up are required to validate this concept.
通过查阅 MEDLINE（2003 年至 2010 年 4 月）中的 463 篇主要和综述文章的摘要，回顾了近期有关“易损斑块”概念的文献范围。易损斑块的建议定义标准包括活跃的炎症、大脂质核心的薄帽、内皮剥落、裂头、严重狭窄，或这些发现的组合。在 242 项主要研究中，评估了颈动脉和冠状动脉斑块的组织病理学、生物标志物和影像学，以评估易损性特征。值得注意的是，这些研究中有 89%是横断面设计，并且仅在已知患有心血管疾病的患者中进行。没有一项影像学研究记录所识别的病变是否与心血管事件有关。横断面设计排除了对生物标志物预测效用的评估。由于易损斑块不是已确立的医学诊断，因此没有进行明确评估易损斑块治疗的研究。很少有研究探讨潜在的系统性治疗（例如他汀类药物）来改变易损性特征。需要在长期随访中有先前心血管事件的患者和无先前心血管事件的患者中进行大型前瞻性研究，以验证这一概念。
