慢性肺原性心脏病急性发作期肺细小动脉血栓形成的病理观察

A Pathological Study of in situ Thrombosis of Small Pulmonary Arteries and Arterioles in Autopsy Cases of Chronic Cor Pulmonale.

目的研究慢性肺心病急性发作期肺细小动脉内血栓形成情况。方法以４９例肺心病急性发作期尸检病例作为研究对象，１０３例同期非肺心病、非ＤＩＣ尸检病例作为对照组。对肺组织及其他脏器切片进行病理学观察，重点观察肺细小动脉中血栓情况。结果肺心病组中４４例存在多发性肺细小动脉血栓，发生率为８９．８％；其中合并较大肺动脉内血栓者９例，发生率为１８．４％；细动脉内血栓占全部血栓的８０％。对照组中仅３例可见肺细小动脉内血栓，发生率为２．９％。所有检出血栓均与血管内膜紧密粘连，提示为原位血栓形成。存在肺细小动脉血栓病例的其他脏器均未见血栓。统计分析显示肺心病组肺细小动脉血栓发生率及血栓量明显高于对照组（Ｐ＜０．０１）。结论多发性肺细小动脉原位血栓形成是慢性肺心病急性发作期极为突出和常见的病理学改变，为临床上提供了新的诊断和治疗标准。

Objective To study the incidence of thrombosis of small pulmonary arteries and arterioles during the exacerbation stage of chronic cor pulmonale. Methods 49 autopsy cases died from the exacerbation of chronic cor pulmonale were chosen as the study group, while other 103 autopsy cases without chronic cor pulmonale and disseminated intravascular coagulation (DIC) as control group. Morphologic and morphometric studies were taken on lung tissues and other organs with focus on the thrombi in small pulmonary arteries and arterioles. Results 44 cases of the study group had multiple thrombi in small pulmonary arteries and arterioles, the incidence is 89.8%, and in 9 of them, thrombi in proximal pulmonary arteries co existed, the incidence is 18.4%. 80% of the thrombi existed in pulmonary arteriole. In control group, only 3 cases had thrombi in small pulmonary arteries and arteriole, the incidence is 2.9%. All thrombi adhered to endangium, implying that they were in situ thrombi. No intravascular thrombosis were found in other organs. χ 2 test showed that the incidence of thrombosis and the number of thrombi in small pulmonary arteries and arteriole in cases with chronic cor pulmonale were significantly higher than that of the control group ( P <0.01). Conclusions Multiple in situ thrombosis in small pulmonary arteries and arterioles is a prominent and common pathological change during the exacerbation stage of chronic cor pulmonale. The study suggests a new diagnostic and therapeutic concept and provides a morphological and theoritical basis for the clinical application of anticoagulants or even the thrombolytic agents for the cases of chronic cor pulmonale in the exacerbation stage.