Department of Medical Nanobiotechnology, Pirogov Russian State Medical University, Moscow, Russia; The Mount Sinai Community Clinical Oncology Program, Mount Sinai Comprehensive Cancer Center, Mount Sinai Medical Center, Miami Beach, FL, USA; Research Center for Children's Health, Moscow, Russia.
Acta Physiol (Oxf). 2015 Mar;213(3):539-53. doi: 10.1111/apha.12438. Epub 2015 Jan 2.
Atherosclerosis is a continuous pathological process that starts early in life and progresses frequently to unstable plaques. Plaque rupture leads to deleterious consequences such as acute coronary syndrome, stroke and atherothrombosis. The vulnerable lesion has several structural and functional hallmarks that distinguish it from the stable plaque. The unstable plaque has large necrotic core (over 40% plaque volume) composed of cholesterol crystals, cholesterol esters, oxidized lipids, fibrin, erythrocytes and their remnants (haeme, iron, haemoglobin), and dying macrophages. The fibrous cap is thin, depleted of smooth muscle cells and collagen, and is infiltrated with proinflammatory cells. In unstable lesion, formation of neomicrovessels is increased. These neovessels have weak integrity and leak thereby leading to recurrent haemorrhages. Haemorrhages deliver erythrocytes to the necrotic core where they degrade promoting inflammation and oxidative stress. Inflammatory cells mostly presented by monocytes/macrophages, neutrophils and mast cells extravagate from bleeding neovessels and infiltrate adventitia where they support chronic inflammation. Plaque destabilization is an evolutionary process that could start at early atherosclerotic stages and whose progression is influenced by many factors including neovascularization, intraplaque haemorrhages, formation of cholesterol crystals, inflammation, oxidative stress and intraplaque protease activity.
动脉粥样硬化是一个连续的病理过程，很早就开始，并经常进展为不稳定斑块。斑块破裂导致有害后果，如急性冠状动脉综合征、中风和动脉血栓形成。易损斑块具有几个结构和功能特征，使其与稳定斑块区别开来。不稳定斑块有大的坏死核心（超过 40%的斑块体积），由胆固醇晶体、胆固醇酯、氧化脂质、纤维蛋白、红细胞及其残留物（血红素、铁、血红蛋白）和死亡的巨噬细胞组成。纤维帽薄，平滑肌细胞和胶原减少，有炎症细胞浸润。在不稳定病变中，新微血管的形成增加。这些新生血管完整性差，渗漏导致反复出血。出血将红细胞输送到坏死核心，在那里降解促进炎症和氧化应激。炎症细胞主要由单核细胞/巨噬细胞、中性粒细胞和肥大细胞组成，从出血的新生血管中逸出，并浸润到支持慢性炎症的外膜中。斑块不稳定是一个进化过程，可能在动脉粥样硬化早期就开始，其进展受到许多因素的影响，包括新生血管形成、斑块内出血、胆固醇晶体形成、炎症、氧化应激和斑块内蛋白酶活性。
