冠心病患者颈动脉-股动脉脉搏波传导速度与升主动脉组织结构成分的相关性研究

The correlation between carotid and femoral pulse wave velocity and composition of the ascending aorta in the patients with coronary disease

目的探讨冠心病患者动脉弹性功能指标颈动脉-股动脉脉搏波传导速度（cfPWV）与升主动脉组织结构成分的相关性。方法入选在我院行冠状动脉旁路移植术（cABG）的老年冠心病患者60例，应用法国Artech—Medical公司生产的脉搏波速度测定仪测定cfPWV。将CABG术中从升主动脉前壁取下的组织进行病理切片，分别用Masson染色平滑肌和胶原纤维，Weigert’s间苯二酚复红法染弹性纤维。光镜下以计算机图像分析系统分别定量测定血管平滑肌、胶原纤维和弹性纤维的相对面积。cfPWV与升主动脉组织结构成分间的相关性应用直线相关分析。结果冠心病患者cfPWV高于正常范围为（14．2±2．0）m／s，升主动脉壁中膜胶原纤维增多为（44．1±3．9）％，弹性纤维减少为（18．4±3．2）％，胶原纤维、弹性纤维和平滑肌排列紊乱。cfPWV与升主动脉中膜胶原纤维的相对含量呈正相关（r=0．68，P〈0．01），与弹性纤维的相对含量呈负相关（r=-0．59，P〈0．01），而与平滑肌的相对含量无相关性（r=0．01，P〉0．05）。结论冠心病患者大动脉弹性下降，其主要病理基础是胶原纤维增多和弹性纤维减少及这两种主要成分的排列紊乱。cfPWV随着升主动脉中膜胶原纤维的增多和（或）弹性纤维的减少而升高。

Objective To investigate the association between carotid-femoral pulse wave velocity （cfPWV） and composition of the ascending aorta in patients with coronary heart disease （CAD）. Methods The study population comprised 60 consecutive CAD patients who underwent coronary artery bypass graft （CABG） surgery in Qilu Hospital of Shandong University. cfPWV was measured using an automatic device （Complior, Artech, France）. A quantitative study was conducted on ascending aorta specimens by histological observation （Masson staining and weigert＇s resorcin-fuchsin staining） and computer image analysis. Bivariate analyses were performed to study the association between composition of the ascending aortic media and cfPWV. Results cfPWV of the CAD patients was higher （14.2±2.0） m/s than that of the normal subjects. On Masson＇s-stained specimen slides, disorganization of smooth muscle and focal accumulations of collagen （44.1 ± 3.9）% were visible along the medial aorta of the CAD patients. Weigert1s-stained cross sections of the ascending aortic media in CAD patients frequently exhibited focal breakdown or discontinuous segments of elastic fibers（18.4 ± 3.2）%. cfPWV had a positive correlation with relative contents of collagen in the ascending aorta（r=0.68, P〈0.01）and a negative correlation with relative contents of elastin in the ascending aorta （r=-0.59, P〈0.01）, but no relation with relative contents of smooth muscle（r= 0. 01, P〉0. 05）. Conclusions The reduced aortic elasticity in CAD patients can be partly ascribed to decreased elastin, increased collagen, and their disorganization, cfPWV can reflect the quantitative changes of collagen and elastin in the ascending aortic media in CAD patients.