中华心血管病杂志
中華心血管病雜誌
중화심혈관병잡지
Chinese Journal of Cardiology
2011年
9期
802-806
,共5页
方芳%张伟%乔旭柏%于启%刘冬戈
方芳%張偉%喬旭柏%于啟%劉鼕戈
방방%장위%교욱백%우계%류동과
冠状动脉硬化%炎症%病理学%尸体解剖
冠狀動脈硬化%炎癥%病理學%尸體解剖
관상동맥경화%염증%병이학%시체해부
Coronary atherosclerosis%Inflammation%Pathology%Autopsy
目的 观察易损斑块在急性冠状动脉综合征患者( ACS)中的病理组织学特点。方法 本研究回顾了北京医院1992-2006年尸检患者127例，分为ACS组67例；与其年龄、性别相匹配的临床表现无ACS的病例60例，从斑块的形态如有无血栓、粥池最大横切面占斑块面积、纤维帽最小厚度、炎细胞浸润密度等10个方面进行形态学观察，观察ACS患者易损斑块发生情况及形态学特点。结果 (1)在ACS组305个斑块中各指标检出率分别为大脂核153个(50.16％)，薄纤维帽187个(61.31％)，有炎细胞浸润263个(86.23％)，可见新生血管217个(71.15％)，严重狭窄26个(8.52％)，有钙化238个(78.03％)，有钙化小结26个(8.52％)，斑块破裂12个(3.93％)，斑块内皮糜烂3个(0.98％)及斑块内出血54个(17.70％)，除斑块糜烂外，其他指标均高于对照组(P均＜0.01)。(2)ACS组和对照组易损斑块检出率分别为89.51％和21.98％ (P ＜0.01)。对每例患者多处斑块观察：ACS组，每例平均观察4.55个切面，易损斑块4.07个，且炎细胞浸润密度大；对照组每例观察3.87个切面，易损斑块0.85个，且炎症程度较轻。结论 ACS患者易损斑块的发生率明显增高，提示易损斑块的形成是ACS发生的重要危险因素。易损斑块的主要形态学特点是大脂核、薄纤维帽、大量炎细胞浸润、内皮有新生血管形成，冠状动脉腔严重狭窄、斑块破裂及内皮细胞糜烂。提示炎性反应可能在易损斑块的形成中起到重要作用。
目的 觀察易損斑塊在急性冠狀動脈綜閤徵患者( ACS)中的病理組織學特點。方法 本研究迴顧瞭北京醫院1992-2006年尸檢患者127例，分為ACS組67例；與其年齡、性彆相匹配的臨床錶現無ACS的病例60例，從斑塊的形態如有無血栓、粥池最大橫切麵佔斑塊麵積、纖維帽最小厚度、炎細胞浸潤密度等10箇方麵進行形態學觀察，觀察ACS患者易損斑塊髮生情況及形態學特點。結果 (1)在ACS組305箇斑塊中各指標檢齣率分彆為大脂覈153箇(50.16％)，薄纖維帽187箇(61.31％)，有炎細胞浸潤263箇(86.23％)，可見新生血管217箇(71.15％)，嚴重狹窄26箇(8.52％)，有鈣化238箇(78.03％)，有鈣化小結26箇(8.52％)，斑塊破裂12箇(3.93％)，斑塊內皮糜爛3箇(0.98％)及斑塊內齣血54箇(17.70％)，除斑塊糜爛外，其他指標均高于對照組(P均＜0.01)。(2)ACS組和對照組易損斑塊檢齣率分彆為89.51％和21.98％ (P ＜0.01)。對每例患者多處斑塊觀察：ACS組，每例平均觀察4.55箇切麵，易損斑塊4.07箇，且炎細胞浸潤密度大；對照組每例觀察3.87箇切麵，易損斑塊0.85箇，且炎癥程度較輕。結論 ACS患者易損斑塊的髮生率明顯增高，提示易損斑塊的形成是ACS髮生的重要危險因素。易損斑塊的主要形態學特點是大脂覈、薄纖維帽、大量炎細胞浸潤、內皮有新生血管形成，冠狀動脈腔嚴重狹窄、斑塊破裂及內皮細胞糜爛。提示炎性反應可能在易損斑塊的形成中起到重要作用。
목적 관찰역손반괴재급성관상동맥종합정환자( ACS)중적병리조직학특점。방법 본연구회고료북경의원1992-2006년시검환자127례，분위ACS조67례；여기년령、성별상필배적림상표현무ACS적병례60례，종반괴적형태여유무혈전、죽지최대횡절면점반괴면적、섬유모최소후도、염세포침윤밀도등10개방면진행형태학관찰，관찰ACS환자역손반괴발생정황급형태학특점。결과 (1)재ACS조305개반괴중각지표검출솔분별위대지핵153개(50.16％)，박섬유모187개(61.31％)，유염세포침윤263개(86.23％)，가견신생혈관217개(71.15％)，엄중협착26개(8.52％)，유개화238개(78.03％)，유개화소결26개(8.52％)，반괴파렬12개(3.93％)，반괴내피미란3개(0.98％)급반괴내출혈54개(17.70％)，제반괴미란외，기타지표균고우대조조(P균＜0.01)。(2)ACS조화대조조역손반괴검출솔분별위89.51％화21.98％ (P ＜0.01)。대매례환자다처반괴관찰：ACS조，매례평균관찰4.55개절면，역손반괴4.07개，차염세포침윤밀도대；대조조매례관찰3.87개절면，역손반괴0.85개，차염증정도교경。결론 ACS환자역손반괴적발생솔명현증고，제시역손반괴적형성시ACS발생적중요위험인소。역손반괴적주요형태학특점시대지핵、박섬유모、대량염세포침윤、내피유신생혈관형성，관상동맥강엄중협착、반괴파렬급내피세포미란。제시염성반응가능재역손반괴적형성중기도중요작용。
Objective To observe pathohistological features of vulnerable plaques in coronary arteries. Methods Autopsy coronary samples from 67 patients died of acute coronary syndrome (ACS) and 60 patients of non-cardiac death from 1992 to 2006 in Beijing Hospital were examined. Morphological features of vulnerable plaques of ACS cases were evaluated in terms of thrombus, ratio of lipid core, the minimal thickness of fibrous cap and the density of inflammatory infiltration. Results ( 1 ) There are 305 plaques in ACS group and the incidence of big lipid core is 153 (50. 16％ ), thin fibrous cap is 187(61.31％),inflammatory infiltration is 263 (86. 23％ ), neovasculature conformation is 217 (71. 15％ ), severe stenosis is 26 ( 8. 52％ ), calcification is 238 ( 78.03％ ), superficial calcified nodule is 26 ( 8. 52％ ), fissured plaque is 12(3.93％ ), endothelial denudation is 3(0. 98％ ) and intraplaque hemorrhage is 54( 17. 70％ ),which are significantly higher than control samples except endothelial denudation ( P ＜ 0. 01 ). ( 2 ) The incidence of vulnerable plaques in ACS group is significantly higher than in the control group (89. 51％ vs.21.98％, P ＜ 0. 01 ). There are 4. 07 sections of vulnerable plaques with high density of inflammatory infiltration out of 4. 55 sections reviewed in ACS patients, while there are 0. 85 sections of vulnerable plaques with mild inflammatory infiltration out of 3. 87 sections reviewed in the control cases. Conclusions Formation of vulnerable plaque was an important pathological factor for the development of ACS. The major morphological characteristics of vulnerable plaque are big lipid core, thin fibrous cap, inflammatory infiltration, neovascularization, severe stenosis, plaque rupture, and endothelial denudation suggesting inflammation performed an important role in the formation of vulnerable plaque.
