为什么要注意发炎

炎症是身体对抗疾病或伤害的一个可见部分. 如果你曾经扭伤过脚踝，你就已经知道了.

But it also can be much less obvious, and researchers are still unraveling its mysteries. Some of what they've learned has intriguing potential for treating heart disease and other illnesses.

"Inflammation is a complex reaction triggered by your immune system when it fights off invaders – such as a virus, 或者它认为是入侵者,”医生说。. Jun Li, a research scientist in the departments of nutrition and epidemiology at the Harvard T.H. 波士顿公共卫生学院的教授. 在基本层面上，大多数被认为是急性或慢性的.

当炎症是对损伤或入侵者(如细菌)的反应时, 病毒或碎片都是急性的. 免疫系统会释放化学物质，导致小血管扩张, 让更多的血液到达受伤组织. Chemicals released at the injured point attract immune system cells to the affected area, 他们在哪里帮助愈合.

Dr. 保罗米. Ridker, director of the Center for Cardiovascular Disease Prevention at Brigham and Women's Hospital in Boston, 说流感是急性炎症的一个例子.

你的肌肉酸痛, 你的关节疼, 你觉得很难受,瑞德说。, 他也是哈佛医学院的尤金·布劳恩瓦尔德医学教授. "That's because all the immune cells in your body are talking to each other saying, ‘嘿, 这里有外来入侵者. 我们必须进攻，我们必须摆脱它.“这是一种巨大的免疫反应，由细胞因子驱动." Cytokines are messages that immune cells use to speak to one another and coordinate an immune response.

Acute inflammation might be treated with steroids or an over-the-counter medicine such as ibuprofen.

如果炎症一直在低水平发酵，那就是慢性的. 这可能由吸烟、肥胖、慢性压力等引发. Chronic inflammation has been linked to cancer, arthritis, diabetes and heart disease.

“我们正在谈论的是一个非常, 非常轻微的炎症反应，人们不会注意到,瑞德说. “它只是在背景中."

在20世纪90年代, Ridker led studies that first associated this chronic inflammation with the risk of heart attack and stroke. He's also led trials showing that lowering such inflammation could protect people from heart problems at levels similar to what's provided by statins, 广为宣传的降胆固醇药物.

Only two anti-inflammatory drugs have been shown to provide this particular heart-protecting benefit.

其中一种药物canakinumab非常谨慎 研究心脏病 但现在正被开发成肺癌药物. 另一种是秋水仙碱，一种用于治疗痛风的廉价药物. 在一个 2019年试验, low-dose colchicine reduced the risk of serious cardiovascular complications after a heart attack by 23% compared to people taking a placebo.

Ridker said he and other cardiologists have been prescribing colchicine to what he dubs "frequent flyers" – people whose heart disease keeps progressing despite aggressive cholesterol-lowering treatment and healthy lifestyles.

筛查一种叫做c反应蛋白的炎症标志物, 或c反应蛋白, 能发现哪些人可能从这种治疗中受益吗.

“有些人更积极, 潜在的细胞因子免疫系统比其他人更强大,瑞德说. “他们不知道. 他们感觉不到. 他们的医生不知道. 如果你没有测量CRP, 就像你的医生测量低密度脂蛋白胆固醇一样, you just don't know if you're one of those people who has this advanced immune response."

瑞克希望这样的检查能成为标准做法. 与此同时，“大多数医生根本不测量炎症，”他说. “所以病人必须主动要求."

李说COVID-19, 哪一种会引发严重的炎症反应, 所谓的细胞因子风暴, 引起了人们对炎症的更多关注和研究. Recent studies are investigating relations between inflammation and the severity and prognosis of COVID-19 infection as well as other chronic illnesses.

She has also looked at how what you eat affects low-level inflammation and your heart. 11月，李 发表了一项研究 in the Journal of the American College of Cardiology linking high-inflammatory diets to the risk of heart disease and stroke.

在一个超过210人的团体中,他们被研究了长达32年, Li's team found those who ate pro-inflammatory diets had a 46% greater risk of heart disease and a 28% greater risk of stroke than those who ate anti-inflammatory diets.

抗炎食物包括绿叶蔬菜, 黄色的蔬菜, 全谷物, 咖啡, 茶和酒. 精制谷物, 含糖饮料和加工过的, 红肉和器官肉与更高水平的炎症有关. A typical example of a healthy diet that also is anti-inflammatory is the Mediterranean diet, 哪一种已经被证明可以降低心脏病和中风的风险.

李教授说，食物如何调节炎症还不完全清楚. 但水果, vegetables and tea contain antioxidants and phytochemicals that can fight off certain chemicals that cause inflammation. Dietary fiber can be metabolized by gut bacteria into chemicals that researchers have found to be associated with lower risk of some chronic diseases.

平衡很重要. 如果你吃了很多促炎食物, 只吃一种消炎食物并不能抵消这种影响, 李说. Similarly, diet doesn't replace anti-inflammatory medicine people have been prescribed.

除了饮食，长期的压力和睡眠不足也可能促进炎症. 然而，运动可以通过减少脂肪来对抗它. "A lot of evidence suggests that excess energy intake and obesity could promote chronic inflammatory processes,李说.

Ridker said several studies are in the works to find new ways to understand and control inflammation. 但他对病人的建议仍然是基本的. "The first thing patients with this underlying inflammation want to do is go to the gym, 扔掉香烟, eat a more healthy diet – and then control their blood pressure and their cholesterol."

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