分叉血管边支斑块及继生斑块发生发展 趋势的动态模拟
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国家自然科学基金项目(12172018),The Royal Society - International Exchanges 2022 Cost Share (NSFC)(IEC\NSFC\223003)


Growth and Development Trend of Lateral Plaques and Subsequent Plaques in Bifurcated Vessels: A Dynamic Simulation
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    摘要:

    目的 考虑血管重构和低密度脂蛋白(low-density lipoproteins,LDL)沉积,探讨分叉血管边支斑块的生长发展趋势,以及因斑块存在而可能引发继生斑块的生长位置。方法 建立分叉血管理想化模型,用计算流体力学方法获取边支斑块生长前后壁面切应力分布。在低切应力区域截取7个截面:截面1 ~ 3为斑块生成前边支的低切应力区域;截面4、5为斑块上、下游边缘;截面6、7为斑块下游低切应力区域。模拟截面内血管重构和LDL沉积,讨论斑块的生长和发展趋势。结果 截面1~3中,截面2产生了明显的负性重构和最高浓度LDL沉积(102.266 mmol/L),说明此处是动脉粥样硬化斑块的起始位置。当斑块产生后,相比于截面4,截面5产生了更明显的血管重构,并造成管腔的狭窄和最高的沉积浓度(110.17 mmol/L),说明斑块有向下游偏心生长的趋势。相比于截面6,截面7(血液流动分离再附着点)产生了更明显的负性重构和最高的沉积浓度(93.851 mmol/L),说明血液流动分离再附着点附近有生成新斑块的可能。结论 边支低切应力处产生明显血管重构导致管腔狭窄,并引发LDL的高浓度沉积,形成动脉粥样硬化斑块。其中,分叉血管的外侧壁为动脉粥样硬化斑块生长的起始位置。在斑块生长后斑块有向下游发展的趋势,在流动分离再附着点有形成继生斑块可能。

    Abstract:

    Objective To investigate vascular remodeling and low-density lipoprotein (LDL) deposition, the growth and development trends of lateral branch plaques in bifurcated vessels, and the potential locations of subsequent plaque growth due to the presence of plaques. Methods An idealized model of bifurcated vessels was established and the distribution of wall shear stress before and after the growth of edge-branch plaques was obtained using computational fluid dynamics. Seven sections were intercepted in the areas of low shear stress: planes 1–3 were the low shear stress areas on the lateral branch before plaque formation, planes 4–5 were the proximal and distal edges of the plaque, and planes 6–7 were the lower shear stress areas of the plaque. Vascular remodeling and LDL deposition in the cross section were simulated. The growth and development trends of plaques are also discussed. Results Among planes 1–3, plane 2 produced obvious negative remodeling and the highest concentration of LDL deposition (102.266 mmol/L), thereby indicating that this was the initial location of the atherosclerotic plaque. Compared to plane 4, plane 5 produced more pronounced vascular remodeling, lumen narrowing, and the highest deposition concentration (110.17 mmol/L) after plaque formation, which indicated that the patch had a tendency for eccentric growth downstream. Compared to plane 6, plane 7 (blood flow separation reattachment site) produced more negative remodeling and the highest deposition concentration (93.851 mmol/L), thereby indicating the possibility of new plaque formation near the reattachment point of blood flow separation. Conclusions Obvious vascular remodeling at low shear stress in the lateral branches leads to lumen stenosis and high LDL deposition, thus, forming atherosclerotic plaques. The lateral wall of the bifurcated blood vessels was the initial location of atherosclerotic plaque growth. After growth, the plaque tends to develop downstream, and subsequent plaques may form at the flow separation and reattachment points.

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刘昭,孙浩,陶克怡,杜田明,张艳萍,刘圣文,冯继玲,乔爱科.分叉血管边支斑块及继生斑块发生发展 趋势的动态模拟[J].医用生物力学,2024,39(5):838-845

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  • 收稿日期:2024-03-01
  • 最后修改日期:2024-03-21
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  • 在线发布日期: 2024-10-25
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