视神经束内营养小动脉硬化引起视神经纤维形态学变化的组织病理学研究

Histopathological study on morphology change of optic nerve fibers caused by atherosclerosis of nutrition artery in optic tract

目的研究颈内动脉粥样硬化和视神经干小动脉硬化与视神经萎缩的关系。方法收集猝死于心脑血管疾病的60～83岁老年人的双侧脑组织标本30例(60个),取颈内动脉和相应的视神经切片行苏木精-伊红染色和Wegert染色,进行病理解剖学研究。结果颈内动脉有粥样硬化改变者55个,占91.7%;视神经内小动脉有硬化改变者45个,占75%。其中纤维增生型15个,占25.0%;纤维斑块型和粥样斑块型28个,占46.6%;钙化斑块型(复合斑块型)17个,占28.4%。视神经束内小动脉有轻度硬化改变者35个,占63.7%;中度改变者14个,占25.3%;重度硬化改变并阻塞小动脉而致视神经萎缩者6个,占11%。结论颈内动脉硬化可同时伴视神经小动脉硬化,小动脉硬化可致视神经缺血萎缩,是引起老年人视野缺损的原因之一。

Background Research demonstrated that brain artery atheroselerosis is one of causes of vision disorders.However,whether arteriosclerosis of internal carotid and tiny nutritional artery within optic tract results in the change of optical nervous fibers has not been proved yet.ObjectiveThis study was to investigate the relationship between atheroselerosis of carotid artery and tiny artery of optic nerve with atrophy of optical nerve.MethodsSixty slides in carotiol and optic nerves from adult brain aged 60-83 years old were collected.Optical nerve specimen of intracranial and intraorbital tracts was obtained and prepared for the hemotoxylin and eosin staining and Wegert staining.ResultsIn 60 samples,artery therosclerosis changes were found in 55 slides（91.7%） and arteriosclerosis in 45 slides（75%）,including fibrous hypertrophy type in 15 slids（25.0%）,fibrous plaque and atheromatous plaque type in 28 slids（46.6%）,calcification plaque type in 17 slids（28.4%）.The histopathological examination revealed that the lesions of the nutritional artery within optic tract and nervous fibers included 3 types according to the different degrees.Mild lesion showed the contract of artery and normal nervous fibers in 35 samples（63.7%）.Moderate lesion presented the obstructive artery and edema of nervous fibers in 14 samples（25.3%）.Calcification of artery wall and atrophy of nervous fibers were seen in severe lesion in 6 samples（11.0%）.Five samples in all the slides did not show obvious arteriosclerosis of internal carotid,and normal morphology of optical nerve fibers also was found.ConclusionThe results suggest that atherosclerosis of carotid tiny artery and atrophy of optic nerve are the rick factors of visual field defect in older population.