急性冠状动脉综合征患者易损斑块的临床病理分析

Clinicopathologic analysis of vulnerable plaque in autopsy with acute coronary syndrome

目的观察易损斑块在急性冠状动脉综合征患者（ACS）中的病理组织学特点。方法本研究回顾了北京医院1992--2006年尸检患者127例，分为ACS组67例；与其年龄、性别相匹配的临床表现无ACS的病例60例，从斑块的形态如有无血栓、粥池最大横切面占斑块面积、纤维帽最小厚度、炎细胞浸润密度等10个方面进行形态学观察，观察ACS患者易损斑块发生情况及形态学特点。结果（1）在ACS组305个斑块中各指标检出率分别为大脂核153个（50．16％），薄纤维帽187个（61．31％），有炎细胞浸润263个（86．23％），可见新生血管217个（71．15％），严重狭窄26个（8．52％），有钙化238个（78．03％），有钙化小结26个（8．52％），斑块破裂12个（3．93％），斑块内皮糜烂3个（0．98％）及斑块内出血54个（17．70％），除斑块糜烂外，其他指标均高于对照组（P均〈0．01）。（2）ACS组和对照组易损斑块检出率分别为89．51％和21．98％（P〈0．01）。对每例患者多处斑块观察：ACS组，每例平均观察4．55个切面，易损斑块4．07个，且炎细胞浸润密度大；对照组每例观察3．87个切面，易损斑块0．85个，且炎症程度较轻。结论ACS患者易损斑块的发生率明显增高，提示易损斑块的形成是ACS发生的重要危险因素。易损斑块的主要形态学特点是大脂核、薄纤维帽、大量炎细胞浸润、内皮有新生血管形成，冠状动脉腔严重狭窄、斑块破裂及内皮细胞糜烂。提示炎性反应可能在易损斑块的形成中起到重要作用。

Objective To observe pathohistological features of vulnerable plaques in coronary arteries. Methods Autopsy coronary samples from 67 patients died of acute coronary syndrome （ACS） and 60 patients of non-cardiac death from 1992 to 2006 in Beijing Hospital were examined. Morphological features of vulnerable plaques of ACS cases were evaluated in terms of thrombus, ratio of lipid core, the minimal thickness of fibrous cap and the density of inflammatory infiltration. Results （ 1 ） There are 305 plaques in ACS group and the incidence of big lipid core is 153 （ 50. 16% ）, thin fibrous cap is 187 （ 61.31% ）, inflammatory infiltration is 263 （86. 23% ）, neovasculature conformation is 217 （71.15%）, severe stenosis is 26 （ 8.52% ）, calcification is 238 （ 78.03% ）, superficial calcified nodule is 26 （ 8. 52% ）, fissured plaque is 12 （3.93%）, endothelial denudation is 3 （0. 98% ） and intraplaque hemorrhage is 54 （17.70%）, which are significantly higher than control samples except endothelial denudation （P 〈 0.01 ）. （2） The incidence of vulnerable plaques in ACS group is significantly higher than in the control group （89. 51% vs. 21.98% , P 〈 0. 01 ）. There are 4. 07 sections of vulnerable plaques with high density of inflammatory infiltration out of 4.55 sections reviewed in ACS patients, while there are 0. 85 sections of vulnerable plaques with mild inflammatory infiltration out of 3. 87 sections reviewed in the control cases. Conclusions Formation of vulnerable plaque was an important pathological factor for the development of ACS. The major morphological characteristics of vulnerable plaque are big lipid core, thin fibrous cap, inflammatory infiltration, neovascularization, severe stenosis, plaque rupture, and endothelial denudation suggesting inflammation performed an important role in the formation of vulnerable plaque.