缺血性脑血管病患者颈内动脉斑块稳定性与氧化型低密度脂蛋白有关

The Relationship between Plaque Stability and Plaque Morphology as well as the Content of Oxidized Low Density Lipoprotein

目的探讨缺血性脑血管病患者颈内动脉斑块的形态学改变以及氧化型低密度脂蛋白表达情况及其与斑块稳定性的关系。方法对8例有缺血性脑血管病症状的死者进行尸体解剖,并对其颈内动脉进行连续取材,光镜观察斑块形态,选取稳定及不稳定斑块各20块进行免疫组织化学染色,观察二者氧化型低密度脂蛋白含量的差异和分布情况。并通过图像分析系统对纤维帽厚度以及氧化型低密度脂蛋白阳性区域进行定量。结果8例缺血性脑血管病组共121个颈内动脉取材块中,不稳定斑块占21.5%(26121);稳定斑块为78.5%(95121)。纤维帽厚度在不稳定组和稳定组分别为0.2±0.1mm和0.5±0.2mm,差异有显著性意义(P<0.01)。免疫组织化学染色显示不稳定斑块和稳定斑块中均有氧化型低密度脂蛋白表达,但不稳定斑块阳性面积明显多于稳定斑块,分别为19.4±3.3和14.3±2.5(P<0.01)。结论缺血性脑血管病患者颈内动脉斑块由稳定和不稳定斑块组成,不稳定纤维帽较薄而且斑块内氧化型低密度脂蛋白阳性区域明显多于稳定斑块,提示氧化型低密度脂蛋白可能是斑块不稳定的重要因素。

Aim To observe the plaque morphological characteristics and oxidized low density lipoprotei （ox-LDL） expression in the carotid arteries of brain ischemia autopsy eases. Methods Serial sections of the carotid arteries of the 8 eases with cerebral ischemia were taken and the morphology of the plaques were observed microscopically. Twenty stable and unstable plaques were ramify selected to do the immunohistochemical staining for ox-LDL. Computer image analysis system was used to measur the thickness of fibrous cap and the ox-LDL content of the stable and unstable plaques, Results 26（21.5% ）of the 121 carotid artery plaques in the 8 eases were unstable plaques;while 95 plaques belong to stable plaques（78.5% ） （ P 〈 0.01 ）. The thickness of the fibrous cap in unstable and stable piques were 0.2 ± 0.1 mm and 0.5 ± 0.2 ram respectively（ P 〈 0.01 ）. staining for ox-LDL were positive in both unstable and stable plaques. But the postive area was significantly larger in unstable plaque than that in stable plaques （ 19.4 ± 3.3 and 14.3 ± 2.5 respectively, P〈0.01）. Conclusion the carotid arteries consist of unstable and stable plaques. The unstable plaque had a relatively thinner fibrous cap than that of stable plaque and the ox-LDL postivity area was larger in unstable plaque than in stable plaque. This indicates that ox-LDL may bear a close correlation with plaque stability.