老年高血压左室肥厚患者心脏微血管病变的特点与心脏事件的关系

The relation between the incidence of cardiac event and myocardial microvascular lesion in hypertensive left ventricular hypertroply in the elderly patients

目的 探讨老年高血压病和冠心病所致左室肥厚患者心脏微血管病变的特点及与心脏事件发生率的关系。方法 从解放军总医院 195 4～ 1996年间 3195例连续尸检心脏标本中 ,选取年龄≥ 6 0岁的高血压病、冠心病、高血压合并冠心病组 181例和对照组 30例共 2 11例心脏标本进行HE、弹力 +VG和CD31免疫组化染色 ,显示心肌间质微血管 ,通过光镜和电脑图像分析、定量检测微血管密度及其壁腔比值、心肌毛细血管密度及其内皮细胞面积 ,并进行统计学处理。结果 高血压时随左室肥厚程度的加重 ,4项指标变化随之明显 ,左室肥厚Ⅱ级时出现心脏事件。各组 4项指标变化与心脏事件的发生率并不一致。结论 高血压时存在心脏微血管病变 ,它与左室肥厚和心脏的事件发生率呈正相关 ;高血压与冠心病引起心脏事件的病理生理学基础有显著区别。

Objective To investigate the characteristics of myocardial microvascular lesion and its relationship with the incidence of cardiac event(ICE) in hypertensive left ventricular hypertroply (LVH),coronary heart disease (CHD) and essential hypertension CHD (EH CHD) in the elderly patients.Methods In the 3?195 autopsy cases from 1954 to 1996 in Chinese PLA General Hospital,a total of 211 hearts from ≥60 years old cases of EH,CHD,EH CUD and control were studied.The myocardial sections of left ventricle were made for each heart and were stained by the methods of routine HE,elastic+VG and immunohistochemical CD31 to observe the microvascular system (arteriole with the diameter of 10 60 μm).The microvascular density,the ratio of wall and lumen,capillary density and its endotnelium area were measured quantitatively by light microscopy and computer image analysis system and the results were analysed statistically.Results The changes in the aforementioned four items became more prominent with the developement of LVH and the ICE occurred in the LVH grade Ⅱ in EH.With the same LVH grade Ⅰ ,the degree of changes in the four items and ICE were quite different in the four study groups.Conclusions There was myocardial microvascular lesion in EH,which has positive correlations with ICE and degree of LVH.The pathophysiological basis of cardiac event was different between EH and CHD.In EH,it is characterized by the microvascular lesion,predominantly involving the lower segment of the coronary arteries,usually resulting in small foci of myocardial lesion with relative low ICE (14.14%);while in CHD,it is mainly due to the atherosclerosis involving the upper segment of cononary arterise,resulting in large foci of myocardial lesion with relatively high ICE (77.78%).The ICE is the highest (78.38%) in EH CHD due to lesions both of the cononary artery and microvascular system.