冠心病猝死者冠状动脉内弹力膜病变与内膜增厚的关系

Relationship between the Pathological Changes of Internal Elastic Lamina and the Intimal Thickness of Coronary Arteries in Patients with Sudden Coronary Death

目的探讨冠心病猝死者（SCD）冠状动脉内弹力膜（internal elastic lamina,IEL）病变与内膜增厚的关系。方法从2001-2005年尸检案例中挑选成年病例及其心脏标本40例,按冠状动脉粥样硬化病变程度和死因分为SCD组（病变≥Ⅲ级）和对照组（病变≤Ⅱ级的非SCD者）,各20例。检查心脏及冠状动脉病变,于左前降支近段取材,制片,弹性纤维和胶原纤维双重染色,光学显微镜下观察其内膜和IEL的变化;用图像分析技术对特殊染色的内膜和IEL进行形态定量分析。结果SCD组冠状动脉左前降支内膜厚度和IEL缺失率均大于对照组,差异均有极显著性意义（P〈0.01）。冠状动脉左前降支的IEL缺失率与内膜厚度的关系：SCD组呈正相关（r=0.3860,P〈0.05）,对照组无相关性（r=0.1681,P〉0.05）。结论SCD者冠状动脉内膜厚度与IEL缺失率具有相关性。

Objective To investigate the relationship between the pathological changes of the internal elastic lamina （IEL） and the intimal thickness of coronary artery in patients with sudden coronary death （SCD）. Methods Forty cases and heart samples autopsied in our department from 2001 to 2005 were selected and divided into 2 groups （20 cases in each group） of SCD with serious atherosclerosis and control group without atherosclerosis according to the degree of coronary atherosclerosis and the cause of death. The samples were taken in the proximal segments of left anterior descending branch （LAD） and embedded by paraffin. The slices were stained by hematoxylin-eosin （HE） and special dual-combination staining （displaying elastic and collagen fibers）. The pathological changes of the tunica intima and IEL of LAD were observed under a light microscope. The intimal thickness and the defective ratio of IEL were quantitatively measured and calculated by image analysis system. Results There was significant difference in the intimal thickness and the defective rate of IEL between the SCD group and control group （P〈0.01）. There was a positive correlation between the defective rate of IEL and the thickness of tunica intima of LAD in the SCD group （r=0.386 0, P〈0.05）, but not in the control group （r=0.168 1, P〉0.05）. Conclusion There is relationship between the IEL defective rate and the thickness of tunica intima of coronary artery in patients with SCD.