Inaba Mayumi, Ueda Makiko
Department of Pathology, Osaka City University Graduate School of Medicine, Japan.
Clin Calcium. 2015 May;25(5):679-86.
Plaque rupture or erosion with subsequent thrombus formation is the principal mechanism underlying the sudden onset of acute coronary syndromes. Plaque inflammation and increased oxidative stress play important roles in the pathogenesis of plaque destabilization. Macrophages, T lymphocytes, and neutrophils are the dominant types of inflammatory cells at human coronary unstable plaques, such as ruptured plaques or eroded plaques. Calcification is a common finding in human atherosclerotic lesions, and arterial calcification is generally classified into calcification within an atherosclerotic plaque, and Mönckeberg's medial calcific sclerosis characterized by calcific deposits within the media of small and medium-sized muscular arteries. It has been reported that a spotty pattern of calcification is associated with coronary unstable ruptured plaques in patients with acute myocardial infarction. Patients undergoing hemodialysis (HD) have a high prevalence of arterial calcification and cardiovascular events. We recently demonstrated that plasma oxidized low density lipoprotein (LDL) levels significantly increased after a single HD session. This HD session-related increase in plasma oxidized LDL levels could contribute to the progression and acceleration of atherosclerosis and arterial calcification, leading to the development of cardiovascular events in HD patients.
斑块破裂或糜烂并随后形成血栓是急性冠状动脉综合征突然发作的主要机制。斑块炎症和氧化应激增加在斑块不稳定的发病机制中起重要作用。巨噬细胞、T淋巴细胞和中性粒细胞是人类冠状动脉不稳定斑块（如破裂斑块或糜烂斑块）中主要的炎症细胞类型。钙化是人类动脉粥样硬化病变中的常见表现，动脉钙化通常分为动脉粥样硬化斑块内的钙化，以及以中小肌性动脉中膜钙化沉积为特征的蒙克贝格中膜钙化性硬化。据报道，斑点状钙化模式与急性心肌梗死患者的冠状动脉不稳定破裂斑块有关。接受血液透析（HD）的患者动脉钙化和心血管事件的患病率很高。我们最近证明，单次血液透析后血浆氧化低密度脂蛋白（LDL）水平显著升高。血液透析相关的血浆氧化LDL水平升高可能促进动脉粥样硬化和动脉钙化的进展与加速，导致血液透析患者发生心血管事件。
