【正文】
隨訪 基線 單純降低 LDL- C無法完全阻止冠心病的發(fā)展 ? 無論何種調(diào)脂藥物心血管事件相對危險降低 25% ? 舉例 1000例患者 ? 安慰劑組 100例事件 ? 治療組 75例(差異 25%) 實際減少 25例事件 誘發(fā)事件的關(guān)鍵因素是斑塊不穩(wěn)定,不穩(wěn)定的斑塊導(dǎo)致急性冠脈綜合征 需要從新的角度思考 CRP是心血管事件一個更強的預(yù)測因子 Ridker PM, J Periodontol. 2020 Aug。79(8 Suppl):154451. Eventfree survival among people (N = 27,939) 免疫因素與粥樣硬化 ? 天然免疫和獲得免疫均參與粥樣硬化的發(fā)生與發(fā)展。 粥樣斑塊內(nèi)的細胞成分 T淋巴細胞與粥樣硬化 受 IP Mig等趨化因子的作用, T淋巴細胞進入斑塊內(nèi),并在 OxLDL、 Hp60等抗原刺激下活化并分泌 INFγ 、 IL10等多種炎性細胞因子。81(1):119. Functional Properties of CD4+ T Cells and Their Possible Role in Plaque Rapture Functional properties Possible role in tissue damage Production of large amount of INFγ Activation of tissuedestructive macrophages Defect in CD40 ligand expression Failure to provide help to B cell to produce protective antibodies Cytotoxicity Induction of apoptosis in smooth muscle cells and endothelial cells Autoreactivity Stimulation by selfantigen Defect in apoptosis Longterm cell survival Clonal expansion Occupation of the “space” and outpeting of other imnunopetent cells Expression of HLA class Ⅰ recognizing receptors Tissue migration amplification of cytotoxicity Unique costimulatory molecules Preferential activation in plaque CD4+CD28null T 淋巴細胞的功能特點 CD4+CD28null T 細胞在 ACS發(fā)病中的作用 Dumitriu IE, Cardiovasc Res. 2020 Jan 1。