颈动脉斑块的病理表现.ppt

稳定斑块 小纤维帽厚而均匀 脂质核体积小 胶原和平滑肌细胞多 炎症细胞少 斑块不容易破溃 不稳定斑块/易损斑块 纤维帽薄且不均匀 脂质核体积大且质软 胶原含量和平滑肌细胞数量减少 斑块内有大量炎症细胞聚集 斑块内有大量的新生血管 斑块易破溃造成血管堵塞导致心梗、脑梗等致命后果 Thank you for your attention! 各种主要危险因素最终都损伤动脉内膜，而粥样硬化病变的形成是动脉对内皮、内膜损伤做出的炎症-纤维增生性反应的结果。动脉内膜受损可为功能紊乱或解剖损伤。在长期血脂异常等危险因素作用下，LDL-C通过受损的内皮进入管壁内膜，并氧化修饰成低密度脂蛋白胆固醇(oxLDL-C)，对动脉内膜造成进一步损伤，单核细胞和淋巴细胞表面特性发生变化，黏附因子表达增加，黏附在内皮细胞上的数量增多，并从内皮细胞之间移入内膜下成为巨噬细胞，通过清道夫受体吞噬oxLDL，转变为泡沫细胞形成最早的粥样硬化病变脂质条纹。巨噬细胞能氧化LDL、形成过氧化物和超氧化离子，在上述生长因子和促炎介质作用下，脂肪条纹演变为纤维脂肪病变及纤维斑块。 * This microscopic cross section of the aorta shows a large overlying atheroma on the left. Cholesterol clefts are numerous in this atheroma. The surface on the far left shows ulceration and hemorrhage. Despite this ulceration, atheromatous emboli are rare (or at least, complications of them are rare). * This high magnification microscopic view of an aortic atheroma shows prominent foam cells as well as cholesterol clefts. * Coronary atherosclerosis is shown here complicated by hemorrhage into the atheromatous plaque. Such hemorrhage acutely may narrow the arterial lumen. * This is severe atherosclerosis of the aorta in which the atheromatous plaques have undergone ulceration along with formation of overlying mural thrombus. * A thrombosis of a coronary artery is shown here in cross section. This acute thrombosis diminishes blood flow and leads to ischemia and/or infarction with damage to the myocardial fibers. This can be evidenced clinically by the onset of chest pain--angina. * Intraplaque hemorrhage without plaque rupture. Superimposed parietal thrombus. A continuous non rup‐ tured thick cap is shown (arrow). A parietal thrombus is implanted in an eroded surface (arrowhead), and a rich lipid core is heavily embedded by intraplaque hemorrhage(LC).Trichrome-stained collagen, blue; hemorrhage, light red; thrombus blue-red (original magnification _200). * * 钙化初期是沉淀在胶原纤维上的磷酸钙矿物小球，在钙化发展过程中，胶原纤维随之钙化并不断富集，形成最终的块状斑块。 * This is the left coronary artery from the aortic root on the left. Extending across th