吸烟肺功能正常者及吸烟COPD患者肺小动脉超微结构的研究

Ultrastructure of Pulmonary Small Arteries in Smokers with Normal Lung Function and with Chronic Obstructive Pulmonary Disease

目的观察吸烟肺功能正常者和吸烟COPD患者肺小动脉超微结构的特征。方法收集33例手术治疗的周围型肺癌患者临床资料,按照有无吸烟史、肺功能结果分为不吸烟肺功能正常组(n=10)、吸烟肺功能正常组(n=13)、吸烟COPD稳定期组(n=10)。取无癌细胞浸润的肺组织标本,光镜下观察计算肺腺泡内肌型动脉比例以及肺小动脉各层面积与血管总面积比值,并与吸烟指数做相关分析。电镜观察肺小动脉的超微结构。结果①与不吸烟肺功能正常者比较,吸烟肺功能正常者和吸烟COPD患者肺腺泡动脉肌型动脉比例增加,肌型动脉内膜面积百分比增大,管腔面积百分比变小。②不吸烟肺功能正常者肺小动脉内膜无增厚,内皮细胞形态正常,平滑肌排列整齐,胞外未见胶原纤维增生。吸烟肺功能正常者肺小动脉内皮细胞表面凹凸不平,血管基底膜增厚,平滑肌细胞外见胶原纤维增生。吸烟COPD患者肺小动脉结构层次紊乱,内皮细胞变性,内膜明显增厚,平滑肌呈合成表型,胶原纤维增生。③吸烟指数与肌型动脉百分比、内膜面积百分比呈显著正相关(r值分别为0.464和0.635,P均<0.05),与管腔面积百分比呈显著负相关(r=-0.603,P=0.002)。结论吸烟肺功能正常者和吸烟COPD患者肺小动脉内皮细胞及平滑肌细胞有相似特点的超微病理改变及肺小动脉重构现象,这些改变与吸烟有显著相关性。

Objective To explore the ultrastructure characteristics of pulmonary arteries in smokers with normal lung function and with chronic obstructive pulmonary disease（COPD）.Methods 33 patients who undertook surgery for peripheral lung cancer were collected.According to smoking history and pulmonary function,the patients were divided into three groups,ie.non-smokers with normal pulmonary function（group A,n=10）,smokers with normal pulmonary function （group B,n=13）,and smokers in stable phase of COPD（group C,n=10）.Normal lung tissues without cancer were sampled and observed under light and electric microscope.Results ①Compared with group A,the thickness of intimal layer of intra-acinar pulmonary muscular arteries of group B and C were significantly higher,the area of their lumen was lower,and the proportion of their muscular arteries was higher（P0.01）.②Ultrastructure of small pulmonary arteries of group A showed that intimal layer was normal,so as to endothelial cells and smooth muscle cells.Collagen fiber was not increased.Ultrastructure observation of group B showed that endothelial cells were distorted,basal membrane was thick,and collagen fiber increased in vessels.Ultrastructure observation of group C showed that endothelial cells degenerated,vascular intima thickness increased,and synthetic phenotype smooth muscle cells increased.③Smoking index was positively correlated with the proportion of muscular arteries and the proportion of intimal area（r=0.464,0.635,P0.05,respectively）,and negatively correlated with the proportion of lumen area（r=-0.603,P0.05）.Conclusions Smokers with normal lung fuction and with COPD show the similar ultrastructural characterizations in endothelial cells,smooth muscle cells,and pulmonary arterial remodeling,which related closely to smoking.