颈内动脉粥样硬化易损斑块的炎细胞、平滑肌细胞和新生血管改变

The pathological changes of inflammatory cells,smooth muscle cell and neo-vessels in the vulnerable carotid atherosclerosis plaque

目的探讨颈内动脉粥样硬化易损斑块内炎细胞、平滑肌细胞和新生血管的病理改变规律。方法 6例男性患者,年龄66～73岁,5例有高血压病史,均无高脂血症,均有颈内动脉系统缺血性脑卒中症状,数字减影血管造影或磁共振血管成像检查证实相应侧颈内动脉血管狭窄程度超过70%。对颈内动脉内膜剥脱的血管标本横断面行常规病理和免疫组织化学染色,后者检查第Ⅷ因子、血管内皮细胞黏附分子-1(VCAM-1)、内皮细胞一氧化氮合酶(eNOS)、α-平滑肌肌动蛋白(α-SMA)、核细胞增殖抗原(PCNA)以及 CD_3、CD_(45)RO 和 CD_(20)。结果斑块内可见坏死、出血和大量脂质沉积,斑块的纤维帽和肩部出现单核细胞和 CD_3、CD_(45)RO 阳性 T-淋巴细胞浸润,局部出现新生毛细血管,毛细血管内皮细胞 VCAM-1和 eNOS 表达阴性。炎细胞浸润部位的平滑肌细胞α-SMA 表达阴性或弱阳性,PCNA 染色阳性。结论颈内动脉易损性粥样硬化斑块内灶性炎细胞浸润部位出现的新生平滑肌细胞以及毛细血管存在功能缺陷,是导致斑块易损重要原因之一。

Objective To study the inflammation, smooth muscle cells and neovessels change in the vulnerable carotid atherosclerosis plaque. Methods 6 male patients, aged between 66-73 years old, had the history of stroke or transient cerebral ischemic attacks of internal carotid artery system in a few clays to 5 months. MRI and DSA revealed marked stenosis of internal carotid artery over 70%. 5 of them had hypertension, none of them had hyperlipidemia. 6 endarterectomy specimens of carotid atherosclerotic plaque were studied. The specimens were fixed in formalin, embedded in paraffin. The sections were examined with routine pathological methods and immunohistological staining with antibodies against yon Willebrand Factor, vascular adhesion molecule-1 （VCAM-1） , endothelial cell nitric oxide synthase （eNOS） , α-smooth muscle actin （SMA）, proliferating cell nuclear antigen （PCNA） and CD3, CD45 RO and CD20. Results Connective tissue proliferation with much lipid storage, hemorrhage, necrosis appeared within the plaque. The fibrous cap of plaque was thin with loss of the endothelial cell. There were focal inflammatory changes and small neo-vessels, more or less in all specimens, in the shoulder and fibrous cap of plaque. Most of the infiltration cells were CD3- and CD45 RO-positive, and CD20-negative. The expression of VCAM-1 and eNOS were negative in the endothelial cell of both plaque surface and the neo-vessels. The expression of α-SMA was negative and PCNA was positive in the smooth muscle cells in the area of inflammatory infiltration. Conclusion In the vulnerable carotid plaque, dysfunction of proliferative smooth muscle cell and neovessels near the inflammatory area might play an important role in the development of vulnerable plaque.