下肢静脉曲张腓肠肌的病理形态学研究

Study on pathologic morphology of gastrocnemius of the varicose veins lower extremities

目的 探讨腓肠肌泵在下肢静脉曲张病理改变中的作用。方法 采用电镜、光镜观察 ,毛细血管基底膜和腓肠肌细胞的图像分析 ,免疫组织化学法 (SP法 )研究 30例下肢静脉曲张病人腓肠肌病理变化 ,并以 10例正常下肢作为对照 ,做出比较分析。结果 (1)光镜观察下 ,下肢静脉曲张病人的腓肠肌可见肌细胞横纹模糊 ,肌膜增生 ,纤维素样变性 ,脂肪变性 ,出血改变 ;(2 )电镜观察下 ,下肢静脉曲张病人的腓肠肌可见毛细血管基底膜增厚、脂滴增多、线粒体肿胀、肌丝断裂、髓样结构、糖原增多、脂褐素、肌病改变。下肢静脉曲张病人的毛细血管基底膜面积及厚度均增高 (P <0 .0 5 ) ;(3)横切面的肌细胞平均周长、直径、面积均增加 ,下肢静脉曲张组与对照组比较有显著性差异 (P <0 .0 0 1)。II ,III级组比I级组面积小 (P <0 .0 5 ) ;(4 )下肢静脉曲张组与正常对照组平均每个肌细胞周围毛细血管数比较无显著性差异 (P >0 .0 5 )。结论 (1)下肢静脉曲张腓肠肌的超微结构病变为缺血、缺氧所致的变性 ,其中毛细血管基底膜增厚起主导作用 ,从而导致腓肠肌泵功能下降 ,加重下肢静脉曲张 ;(2 )肌细胞变性可能与腓肠肌泵功能减弱有关 ;(3)下肢静脉曲张早期可通过肌细胞肥大部分代偿腓肠肌泵功能下降 ,但晚期肌细胞比早期缩小 ,

Objective To investigate the comparative roles of the pathologic changes of gastrocnemius on the pathologic process of varicosis of the lower extremity(VLE). Methods By means of electron microscopy and light microscopy, image analysis and the capillary basement membrane and gastrocnemius muscle cell in 30 patients with VLE and 10 contrast subjects were studied. Results (1) Light microscopically, smearing of cross-striation, sarcolemmal proliferation, fibrinoid degeneration, fatty degeneration, and haemorrhage were seen in muscle of patients with VLE. (2) Electron microscopically, increase in thickness of the capillary basement membrane, increase in lipid droplets and glycogen, swelling of mitochondra, myelin figure, lipofusin, disruption of the myofibrils, and myopathic changes were seen in muscle cells of patients with VLE. The area and thickness of the capillary basement membrane in patients with varicosis were higher than those in the control subjects ( P <0.05). (3) The circumstances, the diameters and the areas of the muscle cell transverse section in patients with VLE were higher than those in control subjects ( P <0.001). The transverse areas in group of class 1 were bigger than those in group class 2 and class 3 ( P <0.05). (4) The mean capillary numbers in every muscle cell between patients with VLE and control subjects was of no significant difference ( P >0.05). Conclusions (1) It is suggested that the ultrastructure changes of gastrocnemius muscles result from ischemia and hgpoxia. Among the changes, the capillary basement membrane plays an important role in the induce insuficiency of the calf muscle pump function which result in VLE extremities. (2) It is suggested that degeneration of gastrocnemius muscle cell may relate to the insufficiency of calf muscle pump function. (3) In early pathologic process, insufficiency of the calf muscle pump function can be compensate by muscle cells hypertrophy. The transverse areas of muscle cells in early period were bigger than that in later period, so that the compensation was limited, chronic ischemia and hypoxia can affecte the calf muscle pump function.