感染与心血管疾病.pptVIP

感染性心内膜炎的临床表现 感染性心内膜炎的诊断标准 * * 首先介绍一下急性感染在引发急性冠脉综合症中的作用。 众所周知：一个进展的冠状动脉病变有两个主要组件：脂质丰富的核心,包含脂滴、炎症细胞、胶原纤维，覆盖在上面的平滑肌细胞和纤维帽。 * 那么流感导致心脏受损的机制是什么呢？急性炎症产生炎症细胞，释放促炎因子，可促进冠脉粥样硬化、管腔狭窄。而血管受损后凝血因子可导致心血管的闭塞，从而导致急性冠脉综合症的发生。 A 几种机制触发冠状动脉粥样硬化斑块的破裂：血小板破坏本身并不足以促进的急性冠脉综合征的发展，急性感染可形成使表面暴露底层形成血栓的物质。 B 局部和系统性形成血栓的条件确定血栓的形成。 C 血栓闭塞的自然的(全部和部分),狭窄的程度、血管收缩,冠状动脉灌注压和心肌代谢平衡(需求与供应)确定急性冠脉综合征的进展。 * TABLE I. Infectious Agents Implicated in Atherosclerosis 传染性病原体在动脉粥样硬化中的作用已经被公认为一个多世纪。William Osler是第一个提出急性感染的在动脉粥样硬化的发病机制一个主要人物。在20世纪初,一些先驱科学家利用一些传染性病原体(伤寒沙门氏菌、链球菌等)诱导动脉粥样硬化动物模型。1970年代末,科学家开始研究疱疹病毒、衣原体肺炎的作用,这一努力恰逢新出现的证据表明动脉粥样硬化炎性疾病。许多科学家在传染性病原体这方面进行了研究,但没有人证明这些病原体是导致急性冠脉病变的原因，也没有必然性。衣原体肺炎研究最为广泛,但大型临床试验的结果对这种疾病应用抗生素很大程度上是令人失望的。 The role of infectious agents in atherosclerosis has been recognized for more than a century. William Osler??was one of the first to propose a major role for acute infection in the pathogenesis of atherosclerosis. In the early 20th century, a few pioneer scientists used several infectious agents (Salmonella typhi, streptococci, etc.) to induce atherosclerosis in animal models. By the late 1970s, scientists began to study the role of herpesviruses and?Chlamydia pneumoniae?and, later, ofHelicobacter pylori,?Mycoplasma pneumoniae,?Porphyromonas gingivalis, enterovirus, and a growing list of other agents in atherogenesis (Table I).??This effort coincided with the emergence of new evidence pointing to atherosclerosis as an inflammatory disease.??The role of infection in endothelial injury and vascular wall inflammation came under scrutiny.??Many infectious agents have been investigated in this regard, but none of them has proved to play a causative and specific role.?Chlamydia pneumoniae?has been studied the most extensively, but the results of large clinical trials of antibiotics against this disease have been largely disappointing. * 这张图显示了流感对凝血系统的影响。 Effects of Influenza on the Coagulation System流感可导致促炎因子的数量、凝血因子大大增加,它导致内皮功能障碍,增加血浆粘度、心动过速、内源性儿茶酚胺的释放。临床流感也与心理压力有关,脱水导致低血压,缺血和血浓缩,血氧不