脑出血急性期患者血肿周围细小动脉的病理改变

Pathological changes of cerebral arterioles around hematoma at acute stage in patients with intracerebral hemorrhage

目的观察脑出血急性期患者血肿周围脑组织细小动脉的病理改变。方法43例脑出血患者于急性期行微创血肿清除术,取手术过程中引流出的血肿内脑组织进行HE及甲醇刚果红染色,观察镜下脑组织细小动脉的病理变化。结果本组有28例(65.12%)脑组织细小动脉的病变基础为细小动脉硬化及玻璃样变,3例(6.98%)可见小动脉粥样硬化,5例(11.63%)可见细动脉内血栓形成;10例(23.26%)脑出血后6h^4d有显著的以中性粒细胞为主的炎细胞黏附及浸润,7例在发病后24h内、1例在24~48h有小灶性出血。结论脑出血患者最常见的病因为细小动脉硬化;中性粒细胞浸润细小动脉为脑出血急性期最重要的病理改变之一。

Objective To observe the pathological changes of cerebral arterioles around hematom in patients with acute period of intracerebral hemorrhage. Methods Brain tissue fragments were collected from the drainage effluents of 43 patients who received mini-invasive puncture drainage treatment of acute intracereal hemorrhage. Pathological changes of arterioles were analyzed under light microscope by routine HE and Congo red staining, respectively. Results The primary pathological changes of cerebral arteriole around hematom was arteriosclerosis and hyaline degeneration, which accounted for 28 cases （65. 12% ）. Other pathological etiological factors included atherosclerosis in 3 cases （6. 98% ） and thrombosis in 5 cases （ 11. 63% ）. Light microscopy also showed neutrophilic granulocytes sticking on the endothelial cells and exuding around vessels in 10 cases （23.26%） from 6h to 4d, and mini-focal hemorrhage in 8 cases （ 18.6% ） from 24 to 48h. Conclusions Arteriosclerosis is the principal pathological etiology for spontaneous intracerehral hemorrhage. Neutrophilic granulocytes infiltrating was one of the most important pathological changes in acute stage of intracerebral hemorrhage.