冠状动脉旁脂肪促进冠状动脉粥样硬化的研究进展

Research progress of the role of pericardial coronary adipose tissue in atherosclerosis

近年来随着对全身脂肪、循环脂质水平升高与冠心病发病关系的临床证据和基础研究的深入,越来越充分的证据表明脂肪组织通过旁分泌、自分泌炎症因子加重全身血管炎症状态、介导胰岛素抵抗、促进血液高凝等途径直接导致冠心病等血管性疾病的发病率大幅增加。传统的冠状动脉粥样硬化理论认为冠状动脉粥样硬化起始于高血压、高血脂、高血糖和其他血管内危险因素导致的血管内皮损伤,继而引起内皮功能紊乱、内膜增生、炎症细胞趋化、脂质累积,最终这些"由内而外"的因素导致动脉粥样硬化斑块的形成,新近的研究渐渐把这种"由外而内"的发病机制和传统的由血管内因素(血浆脂质)异常到内皮功能损害、内膜增殖、脂质斑块形成联系起来,最近的证据表明新生滋养血管与血管壁重构是冠状动脉旁脂肪促进动脉粥样硬化斑块易损的两个重要机制。本文基于现有临床和实验方面的最新证据,阐明冠状动脉旁脂肪组织参与整个动脉粥样硬化的时间和空间过程。

In recent years, with total body fat, circulating lipid levels and coronary heart disease linked progressive consolidation of relevant basic research and clinical evidence more fully show that adipose tissue through paracrine and autocrine mediated by inflammatory cytokines increase systemic vascular inflammation, insulin resistance, blood coagulation pathways lead directly to the significant increase in the incidence of coronary heart disease and other vascular diseases. Coronary atherosclerosis of the traditional theory that vascular endothelial injury of coronary atherosclerosis in hypertension, hyperlipemia, initial hyperglycemia and other vascular risk factors leading to, and then causes endothelial dysfunction, intimal hyperplasia, inflammatory cell chemotaxis, lipid accumulation, eventually these ‘caused by the factors of atherosclerotic plaque inside out＇ formation. Recent studies have come to this ‘outside-in＇ and the pathogenesis of traditional vascular factors（lipid） abnormalities to endothelial dysfunction and intima proliferation, lipid plaques relate. Recent evidence has shown that nourish the blood vessels and vascular wall remodeling are two important mechanisms for fat cornonary bypass to promote atherosclerotic plaque vulnerability. Based on the latest clinical and experimental aspects of the existing evidence, clarify coronary artery atherosclerosis in fatty tissue involved in the whole process of time and space.