冠状动脉内弹力膜缺损与冠心病猝死的关系

Relationship between the defect of internal elastic lamina and sudden coronary death

目的探讨冠状动脉内弹力膜（IEL）病变与冠心病猝死（SCD）的关系。方法从本单位近5年尸检案例中挑选60例病例和心脏标本,分为SCD组、对照组A和B组。每例分别在冠状动脉左前降支近段取材,常规制片,HE和双重组合特殊染色,显微镜下观察冠状动脉IEL,并用图像分析技术对特殊染色的IEL进行形态定量分析。结果60例中,SCD组（男性24例,女性6例,年龄30～83岁）的冠状动脉IEL缺失明显（缺失率=41.64%）,未缺失的IEL失去原有弯曲度而变平直;对照组A（冠心病非猝死者,男性13例、女性2例,年龄41～80岁）的冠状动脉IEL缺失程度较SCD组稍轻（缺失率=30.53%）;对照组B（无冠心病的其他死者,男性8例,女性7例,年龄17～54岁）的冠状动脉IEL仅有轻度缺失（缺失率=15.67%）,多保持原有波浪状结构。统计学分析显示,SCD组与对照组、SCD组与对照组B、对照组A与对照组B之间IEL缺损率的差异均具有极显著性意义;SCD组与对照组A在IEL缺损率上的差异有显著性意义。结论SCD与其冠状动脉IEL缺损率的大小密切相关。

Objective To investigate the relationship of pathological change of internal elastic lamina （IEL） in human coronary arteries （CA） and sudden coronary death （SCD）. Methods Sixty cases and samples of CA were selected from our Department of Forensic Pathology, Tongji Medical college, HUST, which were autopsied from 2001 ～ 2005, and divided into 3 groups （SCD, control group A and B）. The samples were taken from the proximal portions of the left anterior descending （LAD） of CA in the hearts and embedded by usual method. The sections were stained by Hematoxylin-Eosin （HE） and dual-combination staining. The pathological changes of CA, especially IEL, were observed by microscope. The thickness of the intima in CA was measured and the defective rate of IEL was calculated by usual pathological method and image analysis technology. Results Of the 60 subjects, there were 24 males and 6 females with ranging in age from 30 to 83 years old in SCD group, 13 males and 2 females with ranging in age from 41 to 80 years old in control group A （CHD group with severe atherosclerosis in CA）, 8 males and 7 females with ranging in age from 17 to 54 years old in control group B （without severe atherosclerosis in CA）. The defect of IEL was obviously found in SCD group （the defective rate averaged 41.64% ） and the other IEL became straight line and lost original curve. The defect of IEL in control group A （average 30.53% ） was less than SCD group. But the IEL in control group B kept the original curve mostly and seldom defected. The statistical data showed that there were very significant difference of the defective rate of IEL between SCD group and control group, SCD group and control group B, control group A and control group B, and there was significant difference of the defective rate of IEL between SCD group and control group A. Conclusion It is believed that there is close relationship between the degree of defective rate of IEL and SCD.