颅内囊性动脉瘤瘤壁的组织结构变化及其临床意义

Changes in Histological Structure of Walls of Intracranial Saccular Aneurysms and It’s Clinical Meaning

目的观察颅内囊性动脉瘤瘤壁超微病理性结构,预测颅内囊性动脉瘤进展。方法在光学显微镜及电子显微镜下观察12例颅内多发动脉瘤(19个标本)、15例单发动脉瘤及9例重型颅脑损伤患者(对照组)脑血管标本的血管壁组织结构。同时采用免疫组化方法检测各组血管壁标本中的Ⅳ型胶原表达情况。结果在动脉瘤标本中可见动脉瘤壁的内皮细胞损伤、弹力板不完整或缺失及平滑肌细胞坏死,与正常大脑中动脉动脉壁有明显的差异;动脉瘤壁Ⅳ型胶原表达较对照组显著减低(P<0.05)。结论颅内囊性动脉瘤壁中各层结构的形态及分布特点与正常大脑中动脉动脉壁存在较大差异,这可能是颅内囊性动脉瘤容易破裂的原因。

Objective To observe the histological structure of the walls of the intracranial saccular aneurysm （ISA）, and to provide the basis for predicting the development of ISA. Methods The histological structure of ISA walls in the specimens of ISA of 12 patients with multiple ISA （19 specines） and 15 patients with ISA, and the histological structure of the walls of 9 normal middle cerebral arteries （MCA） derived from the patients with brain injury were observed by the optical and the electronic microscope. The expressions of type Ⅳ collagen in the walls of the ISA and normal MCA were determined by immunohistochemical method. Results The endothelial cell injury, the elastic lamellae degeneration or disappearance and smooth muscle cell necrosis or breaking into pieces were observed in the walls of ISA and not in the walls of MCA. The expression of type Ⅳ collagen in the ISA walls was significantly lower than that in the MCA walls （P0.05）. Conclusions There are significantly differences in the histological structural of the walls between ISA and MCA. The easy rupture of ISA may be related to the abnormality of the ISA walls.