动脉粥样硬化与冠心病 1课件

WindausР提出动脉粥样硬化病变中胆固醇含量高Р1913РNikolai N.AnichkovР提出胆固醇能独立导致动脉粥样硬化病变РNikolai N. Anichkov? (1885–1964)Р早期动脉粥样硬化认识大事记Р动脉粥样硬化发病机制的探索Р脂质浸润学说? AS病变主要是因为血浆脂质水平升高所引起。?损伤应答学说? 各种危险因素造成的动脉内膜损伤是AS病变发生的始动环节。?炎症学说? 发现巨噬细胞在斑块中的存在,提出了“动脉粥样硬化是动脉内膜炎”这一“炎症假说”。?氧化学说? 是脂质浸润学说的完善,认为ox-LDL是AS病变发生的中心环节РLDL进入内皮下Р粥样斑块的形成Р斑块破裂,血栓形成,引发事件Р动脉粥样硬化血栓形成(atherothrombosis)Р纤维斑块Р脂肪条纹Р粥样硬?化斑块Р斑块破裂溶合?及血栓形成Р正常Р临床静止期Р心绞痛?TIA?间隙跛行-PADРAMIРStrokeРPADРCvd DeathР年龄增长РSummary of Atherosclerotic ProcessРMultifactorial process (risk factors)?Initiated by endothelial dysfunction?Up regulation of endothelial and leukocyte adhesion molecules?Macrophage diapedesis?LDL transcytosis?LDL oxidation?Foam cells?Recruitment and proliferation of smooth muscle cells (synthesis of connective tissue proteins)?Formation anization of arterial thrombi