尿毒症患者动脉中膜钙化的病理研究

Pathological Study of Arterial Medial Calcification in Uremic Patients

目的研究尿毒症患者动脉中膜钙化的特点,并探讨血管钙化与骨基质蛋白的关系。方法43例尿毒症患者在行动静脉内瘘手术时取桡动脉0.5-1.0cm,应用茜素红染色观察血管钙化情况,应用免疫组化方法观察血管中膜骨桥蛋白（OPN）、Ⅰ型胶原（ColⅠ）、α-平滑肌肌动蛋白（α-SMA）的表达情况。结果43例桡动脉标本中有10例发生程度不同的中膜钙化,钙化率为23.3%;钙化的10例桡动脉中膜平滑肌细胞胞浆均有OPN、ColⅠ阳性表达,没有明显钙化的动脉中仍有51.5%至少存在一种骨基质蛋白的阳性表达,钙化组OPN、ColⅠ阳性表达均明显高于无钙化组,差异有显著性意义（P〈0.01）;而α-SMA在钙化组表达明显减弱,与无钙化组间差异有显著性意义（P〈0.01）。结论尿毒症患者血管中膜可出现明显钙化,OPN、ColⅠ的表达可能是血管钙化的早期标志,血管中膜钙化类似骨的矿化,细胞介导的主动过程可能参与了血管的钙化。

Objective To explore pathological features of arterial medial calcification in uremic patients and relationship between vascular calcification and bone matrix protein. Methods Segments of radial arteries were obtained from 43 uremic subjects during the operation of A - V fistula. Vascular calcification was observed by Alizarin red stain. The expressions of osteopentin （OPN）, type Ⅰ collagen （CoIⅠ） and α -smooth muscle actin （α- SMA） were detected by immunohistochemical staining. Results There were 10 （23.3%） samples of the 43 that had evidence of calcification in the medial layer, accompanying by positive immunohistochemical staining of OPN and Col Ⅰ; moreover, 51.5% of the vessels without overt calcification were observed positive staining of OPN and Col Ⅰ. The expression in the group with calcification was significantly higher than that in the group without calcification （ P 〈0. 01 ） ; while the expression of α - SMA in the group with calcification significantly decreased as compared with that in the group without calcification （ P 〈0. 01 ）. Conclusion There may occur obvious calcification of vascular medial layer in uremic patients, and the expressions of OPN and Col Ⅰ may be its early mark. The arterial medial calcification may be an active, cell - mediated process, which is similar to bone mineralization.