Kristensen S D, Ravn H B, Falk E
Department of Cardiology and Institute of Experimental Clinical Research, Skejby Hospital, Aarhus N, Denmark.
Am J Cardiol. 1997 Sep 4;80(5A):5E-9E. doi: 10.1016/s0002-9149(97)00482-7.
Coronary atherosclerosis without thrombosis is, in general, a benign disease. However, plaque disruption, or fissuring, with superimposed thrombosis, frequently complicates the course of coronary atherosclerosis. Small ruptures often remain clinically silent, whereas more extensive plaque rupture may cause the development of unstable angina, myocardial infarction, and sudden death. The risk of plaque disruption depends more on plaque type (composition) than on plaque size and stenosis severity. Major determinants of a plaque's vulnerability to rupture are: the size and consistency of the lipid-rich atheromatous core; the thickness of the fibrous cap covering the core; and ongoing inflammation and repair within the cap. Both plaque vulnerability (intrinsic disease) and rupture triggers (extrinsic forces) are important for plaque disruption. The former predisposes the plaque to rupture whereas the latter may precipitate it. The resultant thrombotic response, which is important for the clinical presentation and outcome, is portly determined by the reactivity of the circulating platelets and the balance between the fibrinolytic and coagulation systems. New ways of identification and treatment of the dangerous vulnerable plaques responsible for infarction and death, and optimization of antithrombotic treatment, are highly warranted in order to prevent and treat life-threatening coronary thrombosis.
一般来说，无血栓形成的冠状动脉粥样硬化是一种良性疾病。然而，斑块破裂或裂隙伴血栓形成常常使冠状动脉粥样硬化的病程复杂化。小的破裂通常在临床上没有症状，而更广泛的斑块破裂可能导致不稳定型心绞痛、心肌梗死和猝死。斑块破裂的风险更多地取决于斑块类型（成分），而非斑块大小和狭窄严重程度。斑块易破裂的主要决定因素包括：富含脂质的粥样硬化核心的大小和稠度；覆盖核心的纤维帽的厚度；以及帽内持续的炎症和修复。斑块易损性（内在疾病）和破裂触发因素（外在力量）对于斑块破裂都很重要。前者使斑块易于破裂，而后者可能促使其发生破裂。所产生的血栓形成反应对于临床表现和预后很重要，很大程度上由循环血小板的反应性以及纤溶系统和凝血系统之间的平衡所决定。为了预防和治疗危及生命的冠状动脉血栓形成，极有必要采用新的方法来识别和治疗导致梗死和死亡的危险易损斑块，并优化抗血栓治疗。
