Tracy R E
Am J Forensic Med Pathol. 1984 Mar;5(1):15-8. doi: 10.1097/00000433-198403000-00004.
The life span of the human species is about 70 years. The evolutionary strategy used by the species to attain this unusually long life span was not to avoid all coronary plaque formation, but rather to live a long time with coronary plaques in place. Only a rare kind of coronary plaque is thrombogenic and, therefore, fatal in young people. In a forensic service, the author has repeatedly encountered cases of sudden death in men under age 40 wherein a tiny, pale nonocclusive thrombus over a focal plaque was determined to be the cause of death. The histology of these plaques was consistently different from the commonplace innocuous plaques in older subjects. The thrombogenic plaque was marked by the triad: 1) cell-rich, bulky fibrous cap and base accompanying atheronecrosis, 2) phagocytosis in the necrosis-base boundary, and 3) adventitial inflammation. Atheronecrotic bases were commonplace in most innocuous plaques as well as universal in thrombogenic ones. These matters have not been subjected to systematic objective confirmation, and are offered here as hypotheses.
人类的寿命约为70年。该物种用以实现这一超长寿命的进化策略并非是避免所有冠状动脉斑块的形成，而是在冠状动脉斑块存在的情况下长期生存。只有一种罕见的冠状动脉斑块具有血栓形成性，因此会在年轻人中导致致命后果。在法医工作中，作者多次遇到40岁以下男性猝死的案例，其中在局灶性斑块上发现的微小、苍白的非闭塞性血栓被确定为死因。这些斑块的组织学特征始终与老年受试者中常见的无害斑块不同。血栓形成性斑块的特征为三联征：1）伴有粥样坏死的富含细胞、厚实的纤维帽和基部；2）坏死基部边界处的吞噬作用；3）外膜炎症。粥样坏死基部在大多数无害斑块中很常见，在血栓形成性斑块中也普遍存在。这些情况尚未得到系统的客观证实，在此作为假设提出。
