第七章-心血管系统.pptVIP

三、孤立性心肌炎 孤立性心肌炎（Fiedler心肌炎）为一类病因不明的心肌炎，常发生于20－50岁青、中年，急性型常导致心脏扩张，可突然发生心衰而死亡。 其病理类型有： ① 弥漫性间质性心肌炎； ② 特发性巨细胞性心肌炎。 四、免疫反应性心肌炎 免疫反应性心肌炎主要见于一些变态反应性疾病。如风湿性心肌炎、类风湿性心肌炎、系统性红斑狼疮和结节性多动脉炎所致的心肌炎以及某些药物引起的过敏性心肌炎等。 主要病理变化：心肌间质炎伴程度不同的心肌细胞变性、坏死。 Figure 3?Traditional risk factors include age, male sex, dyslipidemia, hypertension, smoking, and diabetes. More recently identified risk factors include obesity and a sedentary lifestyle. KW: CHD, risk factor, obesity, diabetes, BP, smoke, lipid Research studies of patients with no history of CHD have demonstrated that up to 70% of individuals over the age of 35 will have signs of atherosclerotic disease as determined by coronary intravascular ultrasound (IVUS). Nissen S. Am J Cardiol. 2001:87(suppl):15A-20A. Figure 8?There are six stages of development of AS: Grades I – IV: accumulation of lipids, first intracellularly, then extracellularly; Grade V: fibrosis around the lipid core forming an atherosclerotic plaque; Grade VI: complicated plaque (rupture, clot or bleed) leading to a clinical event. KW: artery, arterial wall, atherogenesis, foam cell, fatty streak, lipid core, plaque Modified LDL induces macrophages to release cytokines that stimulate adhesion molecule expression in endothelial cells After modified LDL promotes the differentiation of monocytes into macrophages, the macrophages release a variety of chemicals, including cytokines. Of these cytokines, tumor necrosis factor α (TNF-α) and interleukin-1 (IL-1) activate endothelial cells to express adhesion molecules that bind monocytes, making them available for recruitment into the subendothelial space by MCP-1. Reference: Nathan CF. Secretory products of macrophages. J Clin Invest 1987;79:319-326. Inhibition of adhesion molecules The cytokine-induced expression of adhesion molecules in endothelial cells has been shown in vitro and more recently in vivo to be inhibited by HDL, in a process that potentially blocks a very early inflammatory stage in