青年人冠状动脉粥样硬化病变形态学研究及危险因素探讨

Study on Morphology and Risk Factors of Coronary Atherosclerosis in Young People

目的研究年轻人人群间冠状动脉粥样硬化(CAS)差异以及探讨致 AS 危险因素。方法收集北京地区意外死亡男性年轻人(20～39岁)心脏(<24h)标本96例,分别在冠状动脉(左前降支、左旋支、右冠)近侧端取材,共获得冠脉283支,其中有明显致动脉粥样硬化(AS)危险因素的死亡者(A 组)40例,115支,其他意外(车祸、意外伤害等)死亡者(B 组)56例,168支。常规石蜡包埋,HE 染色,部分标本行 HLA-DR、CD68免疫组化染色和油红 O 染色。光镜观察将 AS 病变分为4型,并对两组人群病变检出率及 CAS 特点进行形态学比较。结果 (1)A 组CAS 病变检出率,尤其是中、晚期病变检出率明显高于 B 组(P=0.003),且在20～24和25～29岁年龄组,中、晚期病变检出明显高于 B 组(P=0.008,P=0.04)。(2)A 组左前降、右冠状动脉 AS 中、晚期病变检出率都高于 B 组,且右冠具有显著性(P=0.040)。(3)A 组斑块内 HLA-DR、CD68阳性细胞含量高于 B组。结论 A 组为 AS 发病高危人群,该组人群这一变化趋势以及造成这一变化的原因,即致 AS 危险因素。

Aim To investigate the coronary atherosclerosis(CAS)among the young people in re- lated to their risk factors.Methods The hearts of 96 young person(age 20～39),who died from acci- dents were collected within 24h postmortemly.The proximal segments of left anterior descending branch (LAD),the left circumflex branch(LC)and the right branch(RC)of the coronary arteries(n=283)were examined.40 cases(group A,115 segments)has so- cial,psychology factors(excitation,depression,and frustation,etc)and other risk factors(smoking,ex- cessive drinking,etc).56 cases(group B,168 seg- ments)had no risk factors.Immunohistochemistry of HLA-DR,CD68 was studied in the portion of vessels with plaques.CAS was classified as four types.Re- sults The overall prevalence rate of CAS in group A,particularly the type Ⅲ and Ⅳ,was significantly higher than in group B(P=0.003).The occurrence of type Ⅲ and type Ⅳ was significantly greater in group A,the subgroup 20～29 years old.The ocur- rence rate of CAS was also higher in the RC of group A,compared with that of group B.The percentage of HLA-DR and CD68 in the plaque of group A was higher than that in group B as well.Conclusion CAS may occur in young people,especially in those with risk factors.