79) Atherosclerosis

Atherosclerosis tseem yog ib qho ntawm cov kev tshawb pom mob tshaj plaws. Coob tus ntawm cov kab mob nrog cov sib txawv sib txawv hauv tsev kuaj mob yog feem ntau cuam tshuam nrog atherosclerosis, thiab ntawm lawv myocardial infarction, mob stroke, mob plab pob txha, qis ceg ischemia.

Lawv feem ntau txiav txim siab txog kev puas hlwb thiab kev tuag. Yog lawm, cov qauv ntawm atherosclerotic quav hniav ua lub luag haujlwm tseem ceeb hauv cov txheej txheem no. Tseeb, nws tau ua tsaug rau cov qauv tshwj xeeb ntawm kev teeb tsa no uas tom qab kuaj mob tshwm sim, uas ua rau muaj kev cuam tshuam tsis zoo rau kev noj qab haus huv ntawm tus neeg, thiab qee zaum kev tuag. Tab sis, txawm tias muaj ntau yam kab mob kev kho mob, feem ntau cov kev mob tshwm sim ntawm atherosclerosis muaj cov kab mob tshwm sim: qhov kev sib tawg ntawm cov kab mob atherosclerotic plaque.

Cov quav hniav sib txawv tuaj yeem sib txawv raws li cov kab tawg me me lossis cov nyom ntawm cov quav hniav los ua rau cov qhov tob ntawm kev puas tsuaj uas txuas mus rau hauv cov mos mos ntawm lub qhov txhab. Hauv txhua kis no, tsawg kawg ntawm qee cov ntshav khov ua tshwm sim.

Lub plab aorta feem ntau mob siab los ntawm kev tsim cov quav hniav, ntxiv rau los ntawm cov teeb meem cuam tshuam nrog cov quav hniav nws tus kheej.

Hauv cov hlab no ntawm lub taub loj, kev rhuav tshem cov quav hniav thiab mob plab tsis xaus nrog occlusion ntawm lumen thiab tuaj yeem ua rau muaj qhov mob ntawm sab saum toj, nrog rau cov ntu loj ntawm aortic phab ntsa, uas tuaj yeem pom nyob rau hauv ntau ntawm cov neeg laus. Ntxiv nrog rau lub luag haujlwm tsis txaus ntseeg ntawm atherosclerosis hauv kev tsim cov mob plab pob txha, qhov ncauj tawm ntawm lub qhov ncauj ua rau muaj kev txaus ntshai tsis txaus ntseeg tias muaj kev mob tshwm sim ntau hauv cov neeg mob no, txawm hais tias cov roj ntsha ua paug yuav muaj cov kab mob hauv lub raum thiab tawv nqaij thaum lub caij qog nqaij.

Txawm li cas los xij, tam sim no tsis meej txog cov dab tsi cuam tshuam ntau cov tshuaj lom biologically active, tso tawm los ntawm thaj chaw yaig ntawm aorta, tuaj yeem muaj rau tib neeg lub cev.

Dab tsi yog qhov sib txawv ntawm cov ntawv qhia ruaj khov thiab tsis ruaj khov?

Hauv cov hlab ntsha ntawm txoj kab uas hla me me, xws li cov hlab ntshav tawm ntawm lub cev, cov kab mob occlusive thrombosis yog ib qho muaj thiab feem ntau ua rau mob hnyav ntawm cov quav hniav tawg. Yog li, nyob rau ntawm cov hlab ntshav ntawm cov hlab ntsha, cov quav hniav tau tshawb xyuas feem ntau dav, thiab ib tug xov tooj ntawm kev sib raug zoo tau txheeb xyuas ntawm cov quav hniav, cov ntshav ntawm cov ntshav txhaws thiab cov hom tom qab ischemic coronary syndromes ntawm cov neeg mob. Cov kev soj ntsuam no tau ua rau lub tswv yim tsis khov kho cov plahaum atherosclerotic plaques - cov plaques nrog cov qauv tsis ruaj khov, ua rau muaj qhov tshwm sim ntawm kev mob ntshav tsis ruaj khov.

Ntau cov kev tshawb fawb tau tsom mus rau kev txheeb xyuas qhov teeb meem xws li tsis khov kho atherosclerotic plaque.

Qhov tsim ntawm atherosclerotic plaque yog qhov tshwm sim ntawm cov kev sib txuam ntawm cov cell hauv cov hlab ntsha uas tshwm sim nruab nrab ntawm cov hlwb tseem ceeb ntawm cov hlab ntsha phab ntsa thiab cov qe ntshav ntawm cov kabmob (ntshav dawb).

Kev cuam tshuam hauv zos cuam tshuam thiab lipids yog lub zog tsav ntawm cov quav hniav tawm yog qhov yuav tsum tau ua nyob rau hauv tus txheej txheem no. Sai li sai athe atherosclerotic quav hniav tau tsim, nws qhia tau hais tias ib tug yam ntxwv heev architecture ntawm fibrous tsim, muaj lub hauv paus tseem ceeb ntawm ntxiv lipids thiab ntau yam kev lwj.

Cov ntaub qhwv ntsej muag muab cov ntaub qhwv tawm cov leeg huv.

Atheroma yog mob me, qaug zog, thiab mob hnyav thrombogenic. Cov quav hniav yog nplua nuj nyob hauv cov txheej txheem tso tawm thiab yog xyaum sib txawv ntawm cov nyob hlwb, tab sis ciam teb rau ntawm daim nyias nyias nrog cov lipids ntawm macrophages.

Unlimited phagocytosis ntawm oxidized LDL nrog kev pab ntawm macrophages ua rau lawv tuag. Kev tuag ntawm cov ntsiab lus no ua lub luag haujlwm tseem ceeb hauv kev tsim thiab loj hlob ntawm atheroma nrog rau kev cais cov leeg ntawm lipids rau collagen fibers thiab proteoglycans.

Quantitative sib txawv hauv cov txheej txheem yam tsis tshua paub: keeb kwm kev tshawb fawb ntawm cov kab ntau ntawm cov quav hniav qhia qhov sib txawv tseem ceeb hauv:

1. lub thickness ntawm lub fiber hau
2. qhov loj ntawm lub atheroma.

Tsis tas li ntawd, qhov sib txawv ntawm cov degree ntawm dystrophic calcination tau qhia.

Txoj kev tshawb no yog qhov tseem ceeb, raws li nws qhia qee yam ntawm cov qhov txhab cuam tshuam nrog cov kev mob tshwm sim ntawm tus kab mob atherosclerotic.

Qhov sib piv ntawm cov nqaij ua mob thiab cov lipids hauv cov quav hniav

Kev sib xyaw ua ke ntawm phab ntsa tuab thiab atheroma loj yuav tshwm sim. Qhov tseem ceeb ruaj khov chaw txhaj tshuaj fibrous pliaj muaj cov ntaub so ntswg nruam thiab tsuas yog ib qho me me ntawm cov lipid tsis tso tawm lossis tsis muaj lipid txhua. Hauv kev mob ntshav ntawm cov hlab ntsha, feem ntau ntawm cov qhov txhab ntshav yuav nyob ntsiag to hauv tsev kho mob thiab tuaj yeem ua rau lub hauv siab ruaj khov hauv lub sijhawm ntev.

Feem ntau cov tshuaj tiv thaiv hauv plaques yog cov yam ntxwv ntawm cov lipid loj muaj pes tsawg leeg thiab muaj nyias los yog ua cov ntawv tsis muaj fiber ntau.

Feem ntau muaj cov lipid-nplua nuj plaques hauv qab qhov kev mob ntawm cov hlab ntshav txha caj qaum.

Lipid plaques pom tias yog "kua muag."

Tsis yog txhua daim plaques hauv cov neeg mob uas muaj tus mob rau cov ntshav khov ua tau raws txoj kev ruaj ntseg no.

Cov kev tshawb fawb pom tau tias rau caum feem pua ​​ntawm cov plaques muaj cov fibrous, tab sis 40% muaj cov lipid tshwj xeeb ntxiv. Tsuas yog 15% ntawm cov neeg mob muaj tag nrho cov plaques uas ua rau mob stenosis thiab mob fibrous, thaum nyob 13% ntawm cov neeg mob yuav luag txhua cov plaques muaj cov tub ntxhais lipid. Qhov tseeb, feem ntau cov neeg mob tau sib xyaw ntawm cov quav hniav tawm hauv cov sib txawv.

Qhov sib txawv ntawm cov keeb kwm keeb kwm nyob rau hauv cov quav hniav thiab nws txoj kev sib raug zoo nrog cov qauv ntawm cov leeg ntshav muaj qee qhov yuav tshwm sim.

Piv txwv, nyias-walled formations feem ntau tawg. Sab hauv cov neeg kho tshuab ua rau ua kom cov quav hniav tawg.

Hauv qhov no, cov ntaub so ntswg ntaub ntawm cov phab ntsa fibrous thiab sab hauv muaj pes tsawg leeg ntawm qhov tsim no tseem ceeb.

Cov txheej txheem quav hniav tsim cov txheej txheem

Atherogenesis yog txoj kev loj hlob ntawm atheromatous plaques.

Nws yog tsiag ntawv los ntawm cov leeg kho tshiab, ua kom muaj kev sib xyaw ua ke ntawm cov khoom muaj roj hu ua cov quav hniav.

Kev loj hlob ntawm atheromatous cov quav hniav yog ib qho txheej txheem qeeb uas muaj kev txhim kho nyob rau ntau xyoo los ntawm cov txheej txheem ua ntu zus ntawm cov xov tooj ntawm tes tshwm sim tsis pub dhau ntawm cov phab ntsa arterial thiab hauv kev teb rau ntau lub nroog vascular circulating yam.

Ib qho kev xav tom qab kawg tau qhia tias vim li cas tsis paub txog vim li cas, cov ntshav dawb, xws li monocytes lossis basophils, pib tawm tsam endothelium ntawm lumen ntawm cov leeg ntshav hauv cov leeg plawv.

Tom qab ntawd tus txheej txheem mob pib tsim, uas, nyeg, ua rau qhov tsim ntawm atheromatous cov quav hniav ncaj qha rau hauv lub qhov tob ntawm txoj leeg ntawm txoj hlab ntsha, thaj av ntawm cov hlab ntsha phab ntsa nyob nruab nrab ntawm cov endothelium thiab daim nyias nyias.

Lub ntsiab ntawm cov kev puas tsuaj muaj cov khoom sau hauv qab no:

• rog nyob rau hauv loj ntau,
• collagen fiber ntau
• elastin.

Thaum xub thawj, cov quav hniav loj hlob tshwm sim, tsuas yog lub thickening ntawm phab ntsa yog pom yam tsis muaj nqaim.

Stenosis yog qhov kawg ntawm lub sijhawm thiab feem ntau yog los ntawm kev rov ua dua ntawm cov quav hniav thiab kho kom zoo, thiab tsis yog los ntawm cov txheej txheem atherosclerotic.

Thaum xub thawj atherogenesis yog tus yam ntxwv los ntawm kev kho kom haum ntawm cov monocytes hauv cov ntshav (ib hom qe ntshav dawb) mus rau lub chaw pw ntawm lub txaj viav vias, nyob rau hauv endothelium, thiab tom qab ntawd lawv cov tsiv teb tsaws hauv qhov chaw endothelial thiab ntxiv kev ua kom tiav rau hauv monocytic macrophages.

Qhov no yog kho los ntawm oxidation ntawm lipoprotein hais sab hauv phab ntsa, hauv qab hlwb endothelial. Hauv cov txheej txheem no, lub luag haujlwm ntau ntxiv yog ua si los ntawm kev ua haujlwm ntxiv ntawm cov piam thaj hauv cov ntshav.

Txog rau thaum kawg, thaum lub sijhawm no, qhov kev txhim kho no tsis tau kawm, thiab cov rog rog tuaj yeem tshwm thiab ploj.

Qhov yooj yim muaj pes tsawg leeg ntawm atherosclerotic plaque

Nws paub tias cov tsim los saum toj no yuav muaj cov qauv sib txawv.

Cov quav hniav tuaj yeem sib txawv hauv nws cov muaj pes tsawg leeg thiab yog qhov ua rau muaj kev txhim kho ntawm ntau yam kev ntshawv siab hauv lub cev.

Nws yog cov khoom siv tseem ceeb ntawm cov quav hniav atherosclerotic uas cuam tshuam dab tsi kuaj pom tus neeg mob yuav muab cov txiaj ntsig.

Ob hom plaques tuaj yeem paub qhov txawv:

1. Ib qho chaw ua haujlwm fibro-lipid (fibro-rog) cov plaque yog qhov txawv txav los ntawm kev thauj ntawm lipid cov hlwb raws li lub cev ntawm cov hlab ntsha, raws li txoj cai, tsis muaj qhov nqaim ntawm lub lumen vim kev tsim kho kom rov qab ntawm cov leeg phab ntsa ua rau cov leeg txheej. Hauv qab ntawm endothelium muaj "fibrous cap" npog ntawm atheromatous "core" ntawm cov quav hniav. Lub nucleus muaj lipid-loaded hlwb (macrophages thiab cov leeg leeg cov leeg) nrog cov roj (cholesterol) thiab cov roj (ester), fibrin, proteoglycans, collagen, elastin thiab cov khib nyiab ntawm tes. Cov plaques no feem ntau ua rau kev puas tsuaj tshaj plaws hauv lub cev thaum lawv tawg. Cov roj khov ua lub hauv paus tuaj yeem ua lub luag haujlwm hauv kev tsim cov quav hniav lub cev.
2. Ib daim hlau ua kom zoo nkauj kuj yog nyob hauv qhov chaw intima, sab hauv ntawm cov leeg phab ntsa, uas ua rau daim ntaub tuab thiab nthuav dav ntawm phab ntsa, thiab qee zaum pom qhov sib nrug ntawm qhov lumen nrog qee qhov atrophy ntawm cov leeg txheej. Cov quav hniav quav muaj cov kab ua collagen (eosinophilic), calcium precipitates (hematoxylinophilic) thiab, tsis tshua pom muaj, txheej lipid.

Qhov tseeb, qhov nqaij leeg ntawm cov leeg phab ntsa ua cov leeg me me lossis, sib hloov, loj txaus los tuav tam sim no atheroma.

Cov leeg ntu ntawm cov phab ntsa ntawm cov leeg feem ntau tseem muaj zog, txawm tias tom qab lawv rov tsim kho kom them nyiaj rau cov tshuaj atheromatous plaques.

Muaj peev xwm tshwm sim ntawm cov quav hniav tsim

Ntxiv nrog rau thromboembolism, ua ntu zus mob atherosclerotic txhab tuaj yeem ua tiav kev kaw ntawm lumen. Lawv feem ntau yog asymptomatic kom txog thaum lub stenosis ntawm lub lumen ua kom loj (feem ntau ntau dua 80%) tias cov ntshav txaus rau cov nqaij mos (s) ua tsis txaus, uas nyob rau hauv lem coj mus rau kev loj hlob ntawm ischemia.

Txhawm rau tiv thaiv kev kuaj mob no, nws yog ib qho tseem ceeb kom paub cov qauv kev kawm ntawv thiab qhia kev kho kom raug.

Atherosclerotic lesions lossis atherosclerotic plaques poob rau hauv ob pawg dav:

• ruaj khov
• thiab tsis ruaj khov (tseem hu ua yooj yim).

Lub pathology ntawm atherosclerotic lesions yog qhov nyuaj heev.

Kev ruaj khov atherosclerotic plaques, uas feem ntau asymptomatic, yog cov nplua nuj nyob hauv cov ntsiab lus sib txawv thiab cov leeg nqaij muaj zog.

Cov plahaum tsis khov yog cov nplua nuj macrophages thiab cov ua npuas ua npuas, thiab cov lej sib ntxiv uas cais cov qhov txhab los ntawm lumen ntawm cov leeg ntshav (tseem hu ua fibrous cap) feem ntau tsis muaj zog thiab nquag tawg.

Kev sib tawg ntawm lub fibrous cap rhuav tshem cov khoom siv thrombogenic thiab thaum kawg ua rau kev tsim ntawm thrombus. Raws li qhov tshwm sim, mob plab intraluminal thom khis tuaj yeem thaiv cov hlab ntsha (piv txwv li, mob hlab plawv), tab sis ntau zaus lawv sib cais, txav thaum cov ntshav ncig thiab, thaum kawg, thaiv cov ceg me nqis txo qis, ua rau mob thromboembolism thiab atherosclerotic cardiosclerosis.

Yuav ua li cas kom yaj cov hmoov av plaques yog piav qhia hauv cov yeeb yaj kiab hauv tsab xov xwm no.