培训课件--血脂异常的危险分层与治疗李广镰.pptVIP

* * * * Figure 35-4 Schematic of the evolution of the atherosclerotic plaque. 1: Accumulation of lipoprotein particles in the intima. The modification of these lipoproteins is depicted by the darker color. Modifications include oxidation and glycation. 2: Oxidative stress, including products found in modified lipoproteins, can induce local cytokine elaboration. 3: The cytokines thus induced increase expression of adhesion molecules for leukocytes that cause their attachment and chemoattractant molecules that direct their migration into the intima. 4: Blood monocytes, upon entering the artery wall in response to chemoattractant cytokines such as monocyte chemoattractant protein 1 (MCP-1), encounter stimuli such as macrophage colony stimulating factor (M-CSF) that can augment their expression of scavenger receptors. 5: Scavenger receptors mediate the uptake of modified lipoprotein particles and promote the development of foam cells. Macrophage foam cells are a source of mediators such as further cytokines and effector molecules such as hypochlorous acid, superoxide anion (O2 - ), and matrix metalloproteinases. 6: Smooth muscle cells in the intima divide other smooth muscle cells that migrate into the intima from the media. 7: Smooth muscle cells can then divide and elaborate extracellular matrix, promoting extracellular matrix accumulation in the growing atherosclerotic plaque. In this manner, the fatty streak can evolve into a fibrofatty lesion. 8: In later stages, calcification can occur (not depicted) and fibrosis continues, sometimes accompanied by smooth muscle cell death (including programmed cell death, or apoptosis) yielding a relatively acellular fibrous capsule surrounding a lipid-rich core that may also contain dying or dead cells and their detritus. IL-1 = interleukin-1; LDL = low-density lipoprotein.  * 大量循证医学证据业已证实降低胆固醇水平可降低冠心病事件的发生率，LDL-C水平与冠心病相对风险呈对数正相关，即当LDL-C = 40 mg/dl时，冠心病相对风险为1.0。 在此基础上，LDL-C水平每变化 30 mg/dl，冠心病相对风险亦相应改变 30%。 * ?长期以来人们认为HDL胆固醇对冠心