冠状动脉内弹力膜缺损与内膜增厚的关系

Relationship Between Defective Internal Elastic Lamina and Intimal Thickening of Human Coronary Arteries *

目的：研究冠状动脉（冠脉）内弹力膜缺损与内膜增厚及动脉粥样硬化发生发展的关系。方法：应用图像分析仪对北京地区１０２例意外死亡年轻人（１５～３９岁）冠脉近侧端进行了形态定量及统计学处理。结果：在同体三支冠脉的比较中内弹力膜缺损程度以左前降支居首位，其次为右冠脉和左旋支。男重于女。内弹力膜缺损程度与内膜增厚呈正相关（ｒ＝０．８７，Ｐ＜０．０１）。紧接内膜增厚高峰之后的年龄组第二弹力膜检出率最高，此后十年间内膜亦无明显进一步增厚。随年龄增长第二弹力膜检出率降低，内膜增厚程度加重。结论：内弹力膜缺损的量与内膜增厚的程度及速度关系密切；第二弹力膜的形成对减慢内膜增厚速度有重要意义。

Objective:To investigate the relationship between defective internal elastic lamina (IEL)and intimal thickening in the development of coronary atherosclerosis (As),306 coronary arteries from 102 autopsied cases,61 males and 41 females,aged 15 to 39 years (divided into 5 age groups) in Beijing were morphometrically studied. Methods:The proximal portions of the left anterior descending (LAD),left circumflex (LC) and right coronary (RC) arteries were taken from hearts (within 48 hr.postmortem) fixed in neutral formalin for 1 week. The specimens were embedded in paraffin,sectioned(4μm)and stained by HE and ET.By using image analysis,intimal thickness was measured and the defective rate of IEL was calculated. Second IEL was identified by light microscopy. Results:Among the 3 coronary arteries (LAD,LC and RC)studied,the defective degree of IEL was most marked in the LAD and then the RC and LC. Males showed more marked defective degree than females ( p <0 01)in the LAD and RC. Detection rate of the second IEL decreased,however intimal thickness increased with ageing.Detection rate of the second IEL was highest in the 25_29 yr.group in males and 20_24 yr.group in females following the age group(20_24 yr. )with peak of intimal thickening,while after the appearance of the second IEL no further intimal thickening was found in the 25_29 and 30_34 yr.guoups. Conclusions:The magnitude of defect of IEL correlates positively with thickness of the intima( r= 0 87, p <0 01). The formation of the second IEL might be significant to retard thickening rate of the intima.