血脂基础知识导论.ppt

* Studies have shown that at least two thirds of all myocardial infarctions (MI) were caused by lesions that have less than 50% stenosis. Unstable plaque rupture can lead to serious complicationsincluding MI, unstable angina, stroke, and peripheral ischemia. Glagov S, et al. N Engl J Med. 1987;316:1371-1375. Hackett D. Eur Heart J. 1988;9:1317-1323. * Stable plaque can cause systemic complications related to vascular occlusion. Complications include stable angina, stroke, renal dysfunction, myocardial infarction, and peripheral ischemia. Virmani R, et al. Arterioscler Thromb Vasc Biol. 2000;20:1262-1275. Libby P. Circulation. 1995;91:2844-2850. * Evidence of atherosclerosis has been seen in patients as youngas teenagers. Vascular remodeling accommodates expansion of the lipid coreand development of fibrous caps with little or no encroachment oninternal lumen, until 30% to 40% of internal elastic membrane isoccupied. Tracy RE, et al. Am J Med Sci. 1995;310 (suppl 1):S37-S41. Strong JP, et al. JAMA. 1999;281:727-735. Glagov S, et al. N Engl J Med. 1987;316:1371-1375. * * * 而冠心病是LDL启动的进展性动脉粥样硬化性疾病，它是一个进展的过程。 LDL进入内皮下，吸引单核细胞进入血管壁，并引发一系列炎症反应，单核巨噬细胞吞噬氧化的LDL，形成泡沫细胞，泡沫细胞死亡后释放游离的LDL，形成脂质核心。 平滑肌细胞的移行和增殖以及纤维组织的沉积使斑块体积不断增大，并引起结构的变化使斑块被纤维帽覆盖。当斑块破裂时，脂质核心里的致血栓物质就被暴露在血液中，引起急性血栓栓塞，造成心肌梗死甚至猝死。1,3 References: 1. Libby P, Ridker PM, Maseri A. Inflammation and atherosclerosis. Circulation. 2002;105:1135-1143. 2. Al Suwaidi J, Hamasaki S, Higano ST, et al. Long-term follow-up of patients with mild coronary artery disease and endothelial dysfunction. Circulation. 2000;101:948-954. 3. Ross R. Atherosclerosis—an inflammatory disease. N Engl J Med. 1999;340:115-126. 4. Libby P. Current concepts of the pathogenesis of the acute coronary syndromes. Circulation. 2001;104:365-372. * ACS的病因治疗 病因治疗 戒烟 降脂治疗 降压治疗 治疗糖尿病 * ACS的药物治疗 ACS的药物治疗 抗血栓治疗 抗缺血治疗 抗凝剂 普通肝素 低分子肝素 溶栓剂 链激酶 尿激酶 抗血小板治疗 环氧化酶抑制剂 ADP受体拮抗剂 抵克立得 氯吡格雷 GPⅡb/Ⅲa受体拮抗剂 阿昔单抗 替罗非班 阿司匹林 硝酸酯类 Β受体阻滞剂 钙拮抗剂 ACEI类药物 他汀类药物 美托洛尔 阿替洛尔 地尔硫