肾脏病与血栓栓塞症血栓与止血研究进展课件.ppt

INT.CLO.04.02.01 NOT FOR DISTRIBUTION/ FOR INTERNAL USE ONLY Please note that neither Sanofi-Synthelabo nor Bristol-Myers Squibb recommends the use of clopidogrel in any manner inconsistent with that described in the full prescribing information. * 幻灯片4 血管损伤部位血栓栓子的形成是一种重要的止血机制，它是通过几种受体介导的交互作用来控制的，产生血小板的粘附、激活和聚集。血小板具有可结合斑块或血管内皮下成分的特殊受体来引导血小板粘附。ADP和凝血酶等受体主要介导血小板的激活，而其他一些受体如糖蛋白Ⅱb/Ⅲa，也就是纤维蛋白受体则主要介导血小板的聚集。伪足与内皮下成分的接触引起血小板的粘附和激活，被激活的血小板变得平坦且脱去部分颗粒，释放形成的介质来吸引和激活更多的血小板。 * 幻灯片4 动脉血栓的病理生理过程开始于动脉管壁内的粥样硬化斑块的发展。许多原因可使动脉粥样硬化斑块产生裂隙或完全破裂，导致凝血因子如胶原蛋白、von Willebrand 因子等暴露于血流中，引起血小板粘附于损伤表面最终形成血栓。然后血栓与动脉粥样斑块相融合使斑块面积增大，动脉管腔更加狭窄。这些过程在临床上可能没有表现，如果斑块保持稳定，这一过程就不会产生临床症状。 但是，如果血栓不稳定而从血管壁脱落，脱落的栓子可能被血流带走并停留于循环的某一部位，特别是血管分叉处，从而引起循环阻塞。另一方面，逐渐增大的血栓本身也可引起动脉栓塞。以上情况都会引起急性血管事件的发生，如心肌梗死、不稳定性心绞痛、缺血性中风、一过性缺血发作甚至缺血性猝死。 INT.CLO.04.02.01 NOT FOR DISTRIBUTION/ FOR INTERNAL USE ONLY Please note that neither Sanofi-Synthelabo nor Bristol-Myers Squibb recommends the use of clopidogrel in any manner inconsistent with that described in the full prescribing information. * References: 1. Falk E et al. Circulation 1995; 92: 657–71. 2. Arbustini E et al. Heart 1999; 82: 269–72. Atherothrombosis is characterized by an unpredictable, sudden disruption (rupture or erosion/fissure) of an atherosclerotic plaque, which leads to platelet activation and thrombus formation. The left hand image illustrates the rapid progression of atherothrombosis, showing a disrupted coronary plaque with occlusive thrombosis superimposed.1 The right hand image shows plaque erosion with an acute coronary thrombosis.2 Atherothrombosis is the underlying condition that results in events leading to myocardial infarction, ischemic stroke, and vascular death. Cardiovascular, cerebrovascular and peripheral vascular disease are part of a continuum of diseases with the common underlying pathophysiology of atherothrombosis. * 幻灯片2 动脉血栓这个术语可以定义为有血栓并发症的动脉粥样硬化，其病理过程包括在有动脉粥样硬化的血管中形成富含血小板的血栓。 动脉血栓是心肌梗死、缺血性中风和血管性死亡