病理学精品课件：e06.pptVIP

Chapter 6 The disease of cardiovascular system Arteriosclerosis : Atherosclerosis ( AS ) Monckeberg media calcific sclerosis Arteriolosclerosis Atherosclerosis characterized by : Intimal lesions called atheroma Fibrofatty plaques that protrude into the lumen Loss of elasticity of underlying media Undergo a serious of complications Primarily affects : Large - sized (elastic) arteries : aorta (abdominal) , carotid arteries Medium - sized muscular arteries : coronary , cerebral , popliteal A 一. Etiology and Pathogenesis (一) Risk factors 1. Hyperlipidemia : ① LDL cholesterol, VLDL, triglycerides Lp (a) promoting ② HDL/HDL-C, apoA-I inhibiting 2. Hypertension: a major risk factor 3. Smoking: ① Endothelial damage, CO↑ PDGF↑, SMC proliferation , emigration →media ② LDL oxidation ox-LDL 4. Diabetes and hyperinsulimemia: ① Hyperglycemia LDL glycolate ox-LDL hypertriglyceride ② Hyperinsulimemia SMC↑、HDL↓ 5. Heredity: 200genes HDL-receptor gene mutation→ family hypercholesterolemia 6. Age and sex： (1) Age: age↑→AS factors changes arterial wall proliferative change (2) Sex: estrogen → HDL postmenopausal female = male  7. Others: Obesity , stressful life type , hypoxia , diet lack of Vit. C , infection of bacteria , virus 8. Lack of exercise : 9. Intake of alcohol : Protective role for moderate intake of alcohol : HDL A large amount of intake of alcohol: hypertension, cerebral hemorrhage (二) Pathogenesis 1. Response to injury hypothesis : (1) Chronic endothelial injury (2) Insudation of LDL into vessel wall (3) Modification of lipoprotein by oxidatin (4) Adhesion of blood monocyte to