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动脉粥样硬化：斑块是怎么形成的

已审核发布 / Reviewed & published · 裁定 approved
Atherosclerosis: how plaque forms审核 medical-reviewer· 2026-07-04· 引用核验 2026-07-04

动脉粥样硬化到底是什么​

动脉粥样硬化（atherosclerosis，Atherosclerosis动脉粥样硬化 · Atherosclerosis/ˌæθəroʊskləˈroʊsɪs/含胆固醇的脂质与炎症细胞在动脉内膜沉积、逐渐形成斑块使管腔狭窄、血管壁变硬的慢性过程。A chronic process in which cholesterol-rich lipids and inflammatory cells accumulate in the arterial intima, gradually forming plaques that narrow the lumen and stiffen the vessel wall.🧩 词根拆解 / word rootsathero-粥样、脂糊状（指斑块柔软的脂质核） · gruel/porridge (the soft fatty core)希腊语 athērē 粥/糊＋scler(o)-硬化、变硬 · hardening希腊语 sklēros 硬＋-osis（病理性）状态、过程 · abnormal condition/process希腊语 -ōsis）是一种常见疾病：当一种黏 性的“斑块”（plaque）在动脉里逐渐堆积时，它就发生了。[1]Tier 3National Heart, Lung, et al. Atherosclerosis --- What Is Atherosclerosis?. 2024https://www.nhlbi.nih.gov/health/atherosclerosis 这种斑块 由血液中的脂肪、胆固醇（cholesterol，Cholesterol胆固醇 · Cholesterol/kəˈlɛstərɒl/一种脂质分子，是细胞膜、类固醇激素和胆汁酸的必需成分；因不溶于水，需由脂蛋白在血液中运输。A lipid molecule essential for cell membranes, steroid hormones, and bile acids; being water-insoluble, it must be transported in the blood by lipoproteins.🧩 词根拆解 / word rootschole-胆汁（最早从胆结石中分离） · bile希腊语 kholē 胆汁＋stere(o)-固体、坚硬 · solid/stiff希腊语 stereos 固体＋-ol醇（化学后缀，表示这是一种醇） · an alcohol (chemistry)）、钙以及其他物质构成，会在 动脉壁内慢慢累积。[1]Tier 3National Heart, Lung, et al. Atherosclerosis --- What Is Atherosclerosis?. 2024https://www.nhlbi.nih.gov/health/atherosclerosis 随着斑块增多，动脉逐渐变窄，流向组织与器官的 富氧血液随之减少。[1]Tier 3National Heart, Lung, et al. Atherosclerosis --- What Is Atherosclerosis?. 2024https://www.nhlbi.nih.gov/health/atherosclerosis

要理解斑块是怎么“长”出来的，我们需要把镜头对准动脉壁最内侧、直接接触血液的那一层——内膜 （tunica intima，Tunica intima内膜 · Tunica intima/ˈtjuːnɪkə ˈɪntɪmə/动脉壁最内、直接接触血液的一层，由一层内皮细胞及其下方的基底膜构成；是动脉粥样硬化最早发生的部位。The innermost layer of the arterial wall, in direct contact with blood, composed of a single layer of endothelial cells on a basement membrane; the site where atherosclerosis first develops.🧩 词根拆解 / word rootstunica外衣、被膜（此处指血管的一层膜） · coat/tunic (a layer/membrane)拉丁语 tunica 外衣＋intima最内的 · innermost拉丁语 intimus 最内），以及铺在它表面的内皮 （endothelium，Endothelium内皮 · Endothelium/ˌɛndoʊˈθiːliəm/铺在血管内腔表面的单层内皮细胞，位于内膜最内侧；通过分泌一氧化氮等活性因子调节血管张力、抑制炎症与血栓，是维持血管稳态的关键界面。The single layer of endothelial cells lining the inner surface of blood vessels, forming the innermost part of the intima; by secreting bioactive factors such as nitric oxide it regulates vascular tone and limits inflammation and thrombosis, serving as a key interface for vascular homeostasis.🧩 词根拆解 / word rootsendo-内、里面 · inside/within希腊语 endon 内部＋-thelium覆盖的细胞层（与 epithelium 上皮同源） · covering cell layer (cognate with epithelium)希腊语 thēlē 乳头/薄膜层）。

动脉粥样硬化的形成步骤

图 · 动脉粥样硬化的五步：LDL 滞留 → 氧化 → 巨噬细胞招募 → 泡沫细胞/脂纹 → 纤维斑块；这是一个持续数十年、可被干预的慢性过程。[2]Tier 1Mach, Francois et al. 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. European Heart Journal 2020doi:10.1093/eurheartj/ehz455[3]Tier 1Bor\'en, Jan et al. Low-density lipoproteins cause atherosclerotic cardiovascular disease: pathophysiological, genetic, and therapeutic insights: a consensus statement from the European Atherosclerosis Society Consensus Panel. European Heart Journal 2020doi:10.1093/eurheartj/ehz962

一切从“滞留”开始​

现代医学把动脉粥样硬化的起始事件归结为一件事：低密度脂蛋白（low-density lipoprotein，LDL低密度脂蛋白 · Low-density lipoproteinLDL/ˌloʊ ˈdɛnsɪti ˌlaɪpoʊˈproʊtiːn/运输胆固醇进入外周组织的脂蛋白颗粒；其携带的胆固醇称 LDL-C，是动脉粥样硬化的核心致病因素，俗称“坏胆固醇”。The lipoprotein particle that carries cholesterol to peripheral tissues; its cholesterol cargo (LDL-C) is a central causal driver of atherosclerosis, popularly called 'bad cholesterol'.🧩 词根拆解 / word rootslow-density低密度 · low density＋lipo-脂、脂肪 · fat希腊语 lipos 脂肪＋protein蛋白质 · protein希腊语 prōtos 第一/首要）以及其他富含胆固醇、携带载脂蛋白B（apolipoprotein B， apoB载脂蛋白B · Apolipoprotein BapoB/ˌæpoʊˌlaɪpoʊˈproʊtiːn biː/每个致动脉粥样硬化脂蛋白颗粒(LDL、VLDL、Lp(a)等)上各携带一个的结构蛋白；apoB 浓度反映致病颗粒总数，是比 LDL-C 更直接的风险指标。The structural protein present as exactly one copy per atherogenic lipoprotein particle (LDL, VLDL, Lp(a), etc.); apoB concentration reflects the total number of atherogenic particles and is a more direct risk marker than LDL-C.🧩 词根拆解 / word rootsapo-载（脱辅基蛋白）、来自/衍生 · the protein moiety; from/derived希腊语 apo 离开/由…而来＋lipo-脂、脂肪 · fat希腊语 lipos 脂肪＋protein蛋白质 · protein＋BB 型（区分 apoA、apoE 等） · class B）的脂蛋白颗粒，在动脉壁内被**滞留（retention）**下来。2019 年 ESC/EAS 血脂异常管理指南明确指出，这种在动脉壁内的滞留是“动脉粥样硬化形成的关键起始事件”。[2]Tier 1Mach, Francois et al. 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. European Heart Journal 2020doi:10.1093/eurheartj/ehz455

欧洲动脉粥样硬化学会（EAS）的共识声明进一步说明：在容易长斑块的部位，内膜下之所以会积聚 LDL， 主要是因为 LDL 被选择性地滞留在内膜里，而不仅仅是被动地渗入。[3]Tier 1Bor\'en, Jan et al. Low-density lipoproteins cause atherosclerotic cardiovascular disease: pathophysiological, genetic, and therapeutic insights: a consensus statement from the European Atherosclerosis Society Consensus Panel. European Heart Journal 2020doi:10.1093/eurheartj/ehz962 换句话说， 血里的致病脂蛋白颗粒越多、暴露时间越久，被“卡”在动脉壁里的机会就越大。

被“氧化”的 LDL 点燃炎症​

被滞留在内膜里的 LDL 并不会安静地待着。它容易被氧化，生成氧化型低密度脂蛋白 （oxidized LDL，oxLDL氧化型低密度脂蛋白 · Oxidized LDLoxLDL/ˈɒksɪdaɪzd ˌɛl diː ˈɛl/被滞留在动脉内膜里的 LDL 颗粒经氧化修饰后形成的产物；它会激活内皮、招募炎症细胞，是引发动脉粥样硬化炎症反应的关键“点火”物质。The product formed when LDL particles retained in the arterial intima undergo oxidative modification; it activates the endothelium and recruits inflammatory cells, acting as a key trigger of the atherosclerotic inflammatory response.🧩 词根拆解 / word rootsoxidized被氧化的 · oxidized＋LDL低密度脂蛋白 · low-density lipoprotein）。[3]Tier 1Bor\'en, Jan et al. Low-density lipoproteins cause atherosclerotic cardiovascular disease: pathophysiological, genetic, and therapeutic insights: a consensus statement from the European Atherosclerosis Society Consensus Panel. European Heart Journal 2020doi:10.1093/eurheartj/ehz962 氧化型 LDL 会启动一场 “无菌性炎症”：它激活内皮细胞，使其表面出现黏附分子并释放趋化因子，把血液里的单核细胞 （monocyte，一种白细胞）招募到动脉壁内。[3]Tier 1Bor\'en, Jan et al. Low-density lipoproteins cause atherosclerotic cardiovascular disease: pathophysiological, genetic, and therapeutic insights: a consensus statement from the European Atherosclerosis Society Consensus Panel. European Heart Journal 2020doi:10.1093/eurheartj/ehz962

这一步很关键：动脉粥样硬化在本质上是一种慢性炎症过程，而不是脂肪单纯“堵”在管子里那么 简单。[4]Tier 3StatPearls Publishing et al. Atherosclerosis. 2023https://www.ncbi.nlm.nih.gov/books/NBK507799/

巨噬细胞、泡沫细胞与脂纹​

进入内膜的单核细胞会分化成巨噬细胞（macrophage，Macrophage巨噬细胞 · Macrophage/ˈmækroʊfeɪdʒ/一种大型免疫细胞，由血液中的单核细胞分化而来，负责吞噬、清除病原体、死亡细胞与脂质等“垃圾”；在动脉粥样硬化中，它吞入大量氧化型 LDL 后会变成泡沫细胞。A large immune cell derived from blood monocytes that engulfs and clears pathogens, dead cells, and debris such as lipids; in atherosclerosis, after taking up large amounts of oxidized LDL it turns into a foam cell.🧩 词根拆解 / word rootsmacro-大 · large希腊语 makros 大＋-phage吞食者、吞噬 · eater/one that devours希腊语 phagein 吃）。[3]Tier 1Bor\'en, Jan et al. Low-density lipoproteins cause atherosclerotic cardiovascular disease: pathophysiological, genetic, and therapeutic insights: a consensus statement from the European Atherosclerosis Society Consensus Panel. European Heart Journal 2020doi:10.1093/eurheartj/ehz962 巨噬细胞本是免疫系统的“清道夫”，本意是清除这些被修饰的脂质；但它们通过特定的清道夫受体 大量吞入氧化型 LDL 后，胞内塞满了胆固醇脂滴，在显微镜下呈现出泡沫状外观——于是变成了 泡沫细胞（foam cell，Foam cell泡沫细胞 · Foam cell/foʊm sɛl/巨噬细胞通过清道夫受体大量吞入氧化型 LDL、胞内充满胆固醇脂滴后形成的细胞，在显微镜下呈泡沫状外观；泡沫细胞聚集是脂纹的核心特征。A cell formed when a macrophage takes up large amounts of oxidized LDL via scavenger receptors and becomes engorged with cholesterol-laden lipid droplets, giving it a foamy microscopic appearance; the aggregation of foam cells is the defining feature of the fatty streak.🧩 词根拆解 / word rootsfoam泡沫（形容胞内脂滴使细胞呈泡沫状） · foam (the foamy look from lipid droplets)＋cell细胞 · cell）。[3]Tier 1Bor\'en, Jan et al. Low-density lipoproteins cause atherosclerotic cardiovascular disease: pathophysiological, genetic, and therapeutic insights: a consensus statement from the European Atherosclerosis Society Consensus Panel. European Heart Journal 2020doi:10.1093/eurheartj/ehz962

大量泡沫细胞聚集在一起，就形成了动脉壁上最早、肉眼可见的病变——脂纹（fatty streak，Fatty streak脂纹 · Fatty streak/ˈfæti striːk/动脉壁上最早、肉眼可见的动脉粥样硬化病变，由内膜里聚集的泡沫细胞构成；脂纹早在儿童期就可出现，是斑块的“雏形”，可进一步进展为纤维斑块。The earliest visible atherosclerotic lesion in the arterial wall, made up of foam cells that accumulate in the intima; fatty streaks can appear as early as childhood and are the precursor lesion that can progress into a fibrous plaque.🧩 词根拆解 / word rootsfatty含脂的、脂肪的 · fatty/lipid-laden＋streak条纹、纹路（病变在血管内呈条纹状） · streak (the lesion appears as a streak)）。[4]Tier 3StatPearls Publishing et al. Atherosclerosis. 2023https://www.ncbi.nlm.nih.gov/books/NBK507799/ 脂纹是泡沫细胞 在内膜里堆积的结果，是斑块的“雏形”。

从脂纹到斑块​

脂纹并不等于终点。在泡沫细胞形成之后，中膜里的平滑肌细胞会向内膜迁移，并合成胶原，逐步把 柔软的脂纹改造成富含胶原的纤维斑块，覆盖在内皮下方。[4]Tier 3StatPearls Publishing et al. Atherosclerosis. 2023https://www.ncbi.nlm.nih.gov/books/NBK507799/ 就这样，早期的脂纹一步步进展为纤维斑块，再到更复杂的动脉粥样硬化病变。[4]Tier 3StatPearls Publishing et al. Atherosclerosis. 2023https://www.ncbi.nlm.nih.gov/books/NBK507799/ 这也解释了动脉粥样硬化这个词的字面含义：既有柔软的“粥样”脂质核心，又有“硬化”的纤维成分。

一个长达数十年、但可以干预的过程​

这条“滞留—氧化—炎症—泡沫细胞—脂纹—斑块”的链条不是一夜之间完成的。动脉粥样硬化性心血管疾病 （atherosclerotic cardiovascular disease，ASCVD动脉粥样硬化性心血管疾病 · Atherosclerotic cardiovascular diseaseASCVD/ˌæθəroʊskləˈrɒtɪk ˌkɑːrdioʊˈvæskjələr/由动脉粥样硬化引起的一类疾病的总称，包括冠心病、缺血性卒中、外周动脉疾病等。An umbrella term for diseases caused by atherosclerosis, including coronary heart disease, ischaemic stroke, and peripheral artery disease.）起病很早，早期的脂纹病变 甚至在儿童期就已开始。[3]Tier 1Bor\'en, Jan et al. Low-density lipoproteins cause atherosclerotic cardiovascular disease: pathophysiological, genetic, and therapeutic insights: a consensus statement from the European Atherosclerosis Society Consensus Panel. European Heart Journal 2020doi:10.1093/eurheartj/ehz962 NHLBI 也指出，斑块往往在童年时期就开始形成， 并随年龄增长而加重。[1]Tier 3National Heart, Lung, et al. Atherosclerosis --- What Is Atherosclerosis?. 2024https://www.nhlbi.nih.gov/health/atherosclerosis

正因为它是一个长期累积的过程，干预才有意义。2019 ESC/EAS 指南强调，升高的 LDL 胆固醇与 ASCVD 之间是因果关系，而尽可能地降低 LDL 及其他含 apoB 的脂蛋白颗粒，能够减少心血管 事件。[2]Tier 1Mach, Francois et al. 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. European Heart Journal 2020doi:10.1093/eurheartj/ehz455 而且这种关系是剂量依赖的：达到的 LDL-C 越低，未来心血管事件的 风险越低。[2]Tier 1Mach, Francois et al. 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. European Heart Journal 2020doi:10.1093/eurheartj/ehz455

从更贴近生活的角度看，NHLBI 指出：大多数人可以通过践行有益心脏健康的生活方式来预防或延缓 动脉粥样硬化的发生；在某些情况下，通过健康的生活方式改变和药物，动脉粥样硬化甚至有可能被 逆转。[1]Tier 3National Heart, Lung, et al. Atherosclerosis --- What Is Atherosclerosis?. 2024https://www.nhlbi.nih.gov/health/atherosclerosis 这也是为什么“越早、越持续地把致病脂蛋白控制下来”如此 重要——你干预的，正是这条要走几十年的链条。

⚕️ 本内容仅供健康科普与学习，不能替代专业医疗建议、诊断或治疗。

参考文献 / References​

  1. Tier 3National Heart, Lung, et al. Atherosclerosis --- What Is Atherosclerosis? (2024) · link
  2. Tier 1Mach, Francois et al. 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. European Heart Journal (2020) · doi:10.1093/eurheartj/ehz455
  3. Tier 1Bor\'en, Jan et al. Low-density lipoproteins cause atherosclerotic cardiovascular disease: pathophysiological, genetic, and therapeutic insights: a consensus statement from the European Atherosclerosis Society Consensus Panel. European Heart Journal (2020) · doi:10.1093/eurheartj/ehz962
  4. Tier 3StatPearls Publishing et al. Atherosclerosis (2023) · link