Campbell J H, Campbell G R
Department of Anatomical Sciences, University of Queensland, Brisbane, Australia.
J Hypertens Suppl. 1994 Dec;12(10):S129-32.
FATTY STREAKS: The precursors of atherosclerotic plaques, fatty streaks, are subendothelial aggregations of lipid-filled macrophages which appear in human arteries within the first decade of life. Some fatty streaks disappear while others progress to fibrous plaques by about the fourth decade.
The major cells comprising plaques are phenotypically modified, smooth-muscle, monocyte-derived, macrophages and T lymphocytes. The monocyte/macrophages and T lymphocytes are chemoattracted into the vessel wall by substances such as oxidized lipoprotein following their adhesion to a dysfunctional endothelium (caused for example by hyperlipidaemia, hypertension or diabetes). The macrophages and T lymphocytes produce specific matrix-degrading enzymes that initiate smooth muscle phenotypic change to a state in which they are responsive to a vast array of mitogens released by cells within the artery wall and by degranulating platelets. Cytokines also released are mediators of an immune response. These processes result in the formation of a thick fibrous cap of proliferated, phenotypically modified, smooth muscle cells and the extracellular matrix that they have produced, overlying a laterally placed cellular region of macrophages, T lymphocytes and smooth muscle cells and a central core of cell debris and cholesterol which has formed from necrotic, lipid-filled macrophages and smooth muscle cells. THROMBI: Ulceration and splitting of the fibrous cap exposes the highly thrombogenic necrotic core to flowing blood, resulting in thrombi which can travel distally to occlude smaller vessels and produce (dependent on the site of the plaque) myocardial infarction, stroke or gangrene of the extremities.
脂肪条纹：动脉粥样硬化斑块的前体是脂质填充的巨噬细胞在内皮下的聚集物，在生命的第一个十年内出现在人类动脉中。一些脂肪条纹会消失，而其他的大约在第四个十年会发展为纤维斑块。
构成斑块的主要细胞是表型改变的平滑肌细胞、单核细胞衍生的巨噬细胞和T淋巴细胞。单核细胞/巨噬细胞和T淋巴细胞在粘附到功能失调的内皮（例如由高脂血症、高血压或糖尿病引起）后，被氧化脂蛋白等物质化学吸引到血管壁中。巨噬细胞和T淋巴细胞产生特定的基质降解酶，引发平滑肌表型改变，使其对动脉壁内细胞和脱颗粒血小板释放的大量有丝分裂原产生反应。释放的细胞因子也是免疫反应的介质。这些过程导致形成一层厚厚的纤维帽，由增殖的、表型改变的平滑肌细胞及其产生的细胞外基质组成，覆盖在横向排列的巨噬细胞、T淋巴细胞和平滑肌细胞的细胞区域以及由坏死的、脂质填充的巨噬细胞和平滑肌细胞形成的细胞碎片和胆固醇的中央核心之上。
纤维帽的溃疡和破裂使高度促血栓形成的坏死核心暴露于流动的血液中，导致血栓形成，血栓可向远端移动以阻塞较小的血管，并产生（取决于斑块的部位）心肌梗死、中风或肢体坏疽。
