尸检老年患者冠状动脉粥样硬化与外周动脉粥样硬化的相关性

Correlation between coronary and peripheral atherosclerosis in elder autopsy cases

目的:观察股动脉、颈总动脉与左冠状动脉前降支各种病变的检出情况,分析老年尸检患者中冠状动脉粥样硬化与外周动脉粥样硬化的相关性。方法:连续收集解放军总医院病理科2003-04/2003-11的尸体解剖病例15例,男13例,女2例,平均年龄(84.9±8.9)岁。尸体纳入标准符合下列两项之一:①年龄≥70岁。②生前有冠心病、脑血管病、周围动脉硬化闭塞症、高血压病史之一。排除标准:有血栓闭塞性脉管炎、动脉内支架植入术、肿瘤病史者。所有病例尸体解剖前均征得家属同意并签署尸检同意书。尸检病例生前有冠心病史者10例,有高血压病史者9例,有脑梗死病史者6例,有下肢动脉硬化闭塞病史者2例。取股动脉、颈总动脉、左冠状动脉前降支标本,在光学显微镜下观察,筛选出有动脉粥样硬化病变的切片,按病理诊断标准分为脂纹、纤维斑块、粥样斑块、复合病变。参照超声中采用的外周动脉粥样硬化评分方法,对每例尸检3个部位的动脉粥样硬化病变分别进行评分,无动脉粥样硬化:0分;脂纹:1分;纤维斑块和粥样斑块:2分;复合病变:3分。动脉粥样硬化程度=∑(病变得分×节段数)。动脉粥样硬化范围按有病变的节段数计算。按以上方法计算出每例病例3种动脉粥样硬化程度及范围的得分。结果:①股动脉(左、右)、颈总动脉(左、右)与左冠状动脉前降支病变检出情况为11/73%,14/93%,12/80%,12/80%,14/93%,斑块的检出情况为10/67%,14/93%,12/80%,11/73%,14/93%。②股动脉和左冠状动脉前降支粥样硬化程度的相关系数为0.47,粥样硬化范围的相关系数为0.41;股动脉和颈总动脉粥样硬化程度的相关系数为-0.01;粥样硬化范围的相关系数为-0.06;颈总动脉和左冠状动脉前降支粥样硬化程度的相关系数为0.49,粥样硬化范围的相关系数为0.37。以上P值均>0.05。结论:股动脉、颈总动脉与左冠状动脉前降支动脉粥样硬化在程度和范围上均无相关性,在同一个体,似不能用股动脉、颈动脉粥样硬化评估冠状动脉动脉粥样硬化的程度和范围。

AIM： To detect the pathological lesions in femoral, carotid, and anterior descending branch of the left coronary, and investigate the relation of atherosclerosis （ATS） lesions between peripheral arteries and coronary in the elder autopsy patients. METHODS： Totally 15 autopsy cases including 13 males and 2 females, mean age of （84.9 ±8.9） years were selected successively from the Department of Pathology, Chinese PLA General Hospital from April to November 2003. Inclusive criterion： （1）aged over 70 years; （2）one of the cases with coronary artery disease （CAD）, cerebrovascular disease, peripheral ATS and hypertensive disease （HD）. Exclusive criterion： with the history of thromboangiitis obliterans, artery endoprothesis implantation or tutor. The relatives all agreed and signed the consent before autopsy. There were 10 CAD cases, 9 HD cases, 6 cases of cerebral infarction, and 2 cases of ATS in lower limbs. Serial sections from three kinds of arteries including femoral, carotid, and anterior descending branch of the left coronary were examined microscopically. The ATS sections were divided into fatty streak, fibrous plaque, atheromatous plaque and combined lesion according to the pathologic diagnosis. Referring to the peripheral ATS score of ultrasound, three ATS lesions in every case was graded as 0 point （no ATS）, 1 point （fatty streak）, 2 points （fibrous plaque and atheromatous plaque） and 3 points （combined lesion）. Degree of ATS=∑ （score of lesion × number of segment）. The range of ATS was calculated with the number of affected segments, and then the grades of the degree and range of ATS were evaluated in each case. RESULTS： （1）The detection rates of femoral （left, right）, carotid （left, right） and anterior descending branch of the left coronary were 11/73%, 14/93%, 12/80%, 12/80%, 14/93%; The detection rates of plaque were 10/67%, 14/93%, 12/80%, 11/73%,. 14/93%, respectively.（2）ln the degree and range of ATS lesions, the correlation coefficient was 0.47 and 0.41 respectively to femoral and anterior descending branch of the left coronary; -0.01 and -0.06 respectively to femoral and carotid arteries; 0.49 and 0.37 respectively to carotid and anterior descending branch of the left coronary （P 〉 0.05）. CONCLUSION： The correlation is absent among femoral, carotid, and anterior descending branch of the left coronary either in the degree or range of ATS lesions. To the same case, it seems that femoral and carotid ATS can not be used to evaluate the degree and range of coronary ATS.