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1、冠心病治療重慶醫(yī)科大學(xué)附屬第一醫(yī)院馬康華 教授CoronaryArteryDiseaseLeadingcauseofdeathinAmericanAbout3-4millionheartattacksyearlythroughouttheworld30%deathrate50%deathoccurwithinthefirsthour中國(guó)面臨心血管疾病第二次浪潮-----冠心病持續(xù)增長(zhǎng)！-----腦卒中居高不下！WhatisCoronaryArteryDisease??CoronaryArteriesRightCoro
2、naryOstiaLeftCoronaryOstiaAorticValveCuspsCoronaryArteriesSinusesofValsalvaRightCoronaryOstiaLeftCoronaryOstiaAscendingAortaLeftAorticCuspPosteriorAorticCuspRightAorticCuspCopyright1989.Novartis.ReprintedwithpermissionfromtheAtlasofHumanAnatomy,illustratedbyFra
3、nkH.Netter,M.D.Allrightsreserved.LeftCircumflexArteryLeftAnteriorDescendingCoronaryArteriesLeftMainCoronaryArteryAnteriorViewRightCoronaryArtery1stDiagonalArtery2ndDiagonalArtery1st&2ndMarginalArteriesCopyright1989.Novartis.ReprintedwithpermissionfromtheAtlasof
4、HumanAnatomy,illustratedbyFrankH.Netter,M.D.Allrightsreserved.BloodSupplyoftheHeartDerivesfrom3coronaryarteriesleftanteriordescendingarteryLeftcircumflexarteryRightcoronaryarteryNarrowingofanyofthesecoronaryarteriescausescoronaryarterydisease定義冠狀動(dòng)脈粥樣硬化性心臟病(coro
5、naryatheroscleroticheartdisease)指冠狀動(dòng)脈粥樣硬化使血管腔阻塞，導(dǎo)致心肌缺血、缺氧而引起的心臟病，它和冠狀動(dòng)脈功能性改變(痙攣)一起，統(tǒng)稱冠狀動(dòng)脈性心臟病(cronaryheartdisease)，簡(jiǎn)稱冠心病，亦稱缺血性心臟病(ischemicheartdisease)。發(fā)病機(jī)制脂肪浸潤(rùn)學(xué)說(shuō)：LDL和VLDL特別是氧化修飾的LDL，經(jīng)損傷的內(nèi)皮細(xì)胞或內(nèi)皮細(xì)胞裂隙→中膜，平滑肌細(xì)胞增殖、吞噬脂質(zhì)→泡沫細(xì)胞，脂蛋白又降解而釋出各種脂質(zhì)，刺激纖維組織增生，共同構(gòu)成粥樣斑塊血小板聚集和血栓形成
6、學(xué)說(shuō)：粥樣斑塊實(shí)際上是機(jī)化了的血栓，并非真正的粥樣斑塊內(nèi)皮損傷反應(yīng)學(xué)說(shuō)：各種危險(xiǎn)因素?fù)p傷內(nèi)膜→炎癥反應(yīng)→動(dòng)脈粥樣硬化斑塊形成動(dòng)脈粥樣硬化的發(fā)病機(jī)理迄今為止AS的確切機(jī)制尚未完全闡明，近年來(lái)較一致的認(rèn)為:多種危險(xiǎn)因素↓內(nèi)皮功能紊亂(炎癥的啟動(dòng)因子)↓OX-LDL浸潤(rùn)→形成泡沫細(xì)胞(關(guān)鍵環(huán)節(jié))↓細(xì)胞因子、炎性介質(zhì)、生物酶及平滑肌細(xì)胞增值遷移↓導(dǎo)致動(dòng)脈壁炎癥動(dòng)脈粥樣硬化的發(fā)病機(jī)理DiseaseProcessNormalCoronaryArteryCopyright1989.Novartis.Reprintedwithper
7、missionfromtheAtlasofHumanAnatomy,illustratedbyFrankH.Netter,M.D.Allrightsreserved.DiseaseProcessCopyright1989.Novartis.ReprintedwithpermissionfromtheAtlasofHumanAnatomy,illustratedbyFrankH.Netter,M.D.Allrightsreserved.泡沫細(xì)胞脂質(zhì)條紋中層受損粥樣斑塊纖維斑塊繼發(fā)損傷/破裂內(nèi)皮損害firstdecade
8、ThirddecadeForthdecadeAdaptedfromStaryHCetal.Circulation1995;92:1355-1374.冠脈疾病機(jī)理AT各階段的治療方案不同LibbyP.Circ2001;104:365,介入治療ASA氯吡格雷肝素/LMWHGPIIb/IIIa拮抗劑Beta受體阻滯劑改善生活方式控制危險(xiǎn)因素ASA他汀
