Davies M J
BHF Cardiovascular Pathology Unit, St George's Hospital Medical School, University of London, UK.
Br Med Bull. 1994 Oct;50(4):789-802. doi: 10.1093/oxfordjournals.bmb.a072926.
The major cause of human arterial thrombosis is atherosclerosis. Thrombosis over atherosclerotic plaques is either due to superficial or to deep injury. In superficial injury there is endothelial denudation with thrombi adherent to the surface of the plaque. In deep injury more major plaque disruption exposes the lipid core to the lumen. Blood enters the core and thrombus forms within the plaque expanding its volume rapidly. Later thrombosis may, or may not, extend into the lumen leading to occlusion. Plaque disruptions heal by smooth muscle proliferation. Either form of thrombosis may occur in minor forms which invoke plaque growth alone or in major forms which precipitate clinical symptoms. In large arteries, such as the carotid, plaque disruption leads to chronic ulceration with exposed thrombus acting as a nidus for distal embolisation. Plaques with a high lipid and macrophage content in which smooth muscle cell numbers are low are at the greatest risk of disruption.
人类动脉血栓形成的主要原因是动脉粥样硬化。动脉粥样硬化斑块上的血栓形成要么是由于表面损伤，要么是由于深层损伤。在表面损伤中，存在内皮剥脱，血栓附着于斑块表面。在深层损伤中，更严重的斑块破裂使脂质核心暴露于管腔。血液进入核心，血栓在斑块内形成，迅速扩大其体积。随后血栓形成可能会，也可能不会，延伸至管腔导致阻塞。斑块破裂通过平滑肌增殖而愈合。这两种血栓形成形式都可能以仅引起斑块生长的轻微形式出现，或者以引发临床症状的严重形式出现。在大动脉中，如颈动脉，斑块破裂会导致慢性溃疡，暴露的血栓成为远端栓塞的病灶。脂质和巨噬细胞含量高而平滑肌细胞数量低的斑块破裂风险最大。
