冠状动脉易损斑块愈合的新进展

New advances in the healing of vulnerable coronary plaques

易损斑块愈合是急性冠状动脉综合征(acute coronary syndrome,ACS)的重要保护机制。易损斑块破裂或侵蚀引起的血小板聚集、血栓形成是斑块愈合的先决条件,局部血栓溶解、肉芽组织生成、血管再内皮化实现血管再通可形成亚临床状态,截断ACS的病理进程。大量临床数据提示愈合的斑块可能与患者的亚临床病变稳定化相关,但其具有较高的血管炎症水平及斑块易损性等不稳定特征,提示早期干预治疗是促进斑块愈合的重要手段。氧化三甲胺、脑源性神经营养因子等生物标志物可提示斑块愈合情况,及时给予稳定斑块、促进易损斑块愈合的治疗,可为预防ACS发病及死亡提供新思路。

The healing of vulnerable plaques is a crucial protective mechanism against acute coronary syndrome(ACS).Plaque rupture or erosion leading to platelet aggregation and thrombus formation is a prerequisite for plaque healing.Local thrombus dissolution,granulation tissue formation,and re-endothelialization of the vessel,achieving vascular recanalization,can result in a subclinical state that interrupts the pathological progression of ACS.Extensive clinical data suggest that healed plaques may be associated with the stabilization of subclinical lesions in patients;however,they also exhibit high levels of vascular inflammation and plaque vulnerability,indicating that early intervention is a key strategy to promote plaque healing.Biomarkers such as trimethylamine N-oxide and brain-derived neurotrophic factor can indicate the status of plaque healing.Timely treatment aimed at stabilizing plaques and regulating the healing of vulnerable plaques may provide new approaches to preventing the onset of ACS and reducing mortality.