老年高血压左心室肥厚患者冠状循环微血管病理改变特点

Characteristics of coronary microvascular lesion in the autopsied elderly cases with hypertensive left ventricular hypertrophy

目的 了解老年高血压左心室肥厚 (LVH)患者冠状循环微血管病变的特点 ,并在LVH分级相同的条件下 ,观察高血压、冠心病、糖尿病心肌微血管病变的区别。方法 从我院 195 4～ 1996年的 3 195例连续尸检标本中选取年龄≥ 60岁的高血压病、冠心病、高血压合并冠心病、糖尿病 2 0 6例和对照组 3 0例的心脏标本进行HE、弹力 +VanGieson和CD3 1免疫组化染色 ,显示心肌间质 10～ 60μm动脉和心肌毛细血管 ,通过光镜和电脑图像分析 ,定量检测微动脉密度及其壁腔比值、心肌毛细血管密度及其内皮细胞面积 4项指标 ;根据左室游离壁厚度将LVH分为 0级～III级 ;高血压组LVH 0～III级 ,冠心病组、高血压合并冠心病组、糖尿病组LVH均为I级。各组间比较采用SAS系统处理。结果 各组冠状循环微血管定量测定结果显示 :高血压组随LVH加重 ,微动脉密度和壁腔比值逐渐增大 ,而毛细血管密度与内皮细胞面积逐渐减小 ;高血压合并冠心病LVH组有类似改变但程度更重 ;冠心病LVH组微动脉密度增加而其他指标变化不明显 ;糖尿病组壁腔比值无明显改变 ,而微动脉密度增高 ,毛细血管密度及内皮细胞面积明显减少。结论 高血压LVH时冠状循环微血管段的改变表现为微动脉密度增高 ,壁腔比值增大和毛细血管减少 ,其中壁腔比值增大是高血压LVH?

Objective To observe the characteristics of coronary microvascular lesion (CML) in the autopsied elderly cases with hypertensive left ventricular hypertrophy (LVH) and the difference of CML among the groups of hypertension, coronary artery disease and diabetes under the condition of same LVH stage. Methods A retrospective study was performed in 206 cases over 60 years old of hypertension (HT), coronary artery disease (CAD) and diabetes (NIDDM) with LVH and 30 normal cases as control out of 3 195 consecutive autopsied cases from 1954 to 1996 in our hospital. The arteriole with the diameter of 10-60 μm and the capillary in muscular layer were shown by the methods of HE, Elastic fiber +VG staining and immunohistochemistry of CD31. Quantitative measurements on the arteriole density (AD), the ratio of arteriole wall and cavity (RWC), the capillary density (CD) and the area of endothelial cell (AEC) were performed by light microscope observation and image analysis by computer. According to the free wall thickness of left ventricle, the severity of LVH was divided into four degrees from 0 to Ⅲ, which was 0- Ⅲ degree in HT group and I degree respectively in CAD, HT+CAD and NIDDM groups. SAS system was used for the statistic analysis. Results The AD and RWC increased while CD and AEC decreased significantly with the aggravation of LVH in HT group (P<0.05-0.01). There was a similar morphological change but in more severe degree in the group of HT+CAD compared with HT group (P<0.01). The AD increased (P<0.05), while RWC, CD and AED did not change significantly in CAD group. The AD increased, CD and AEC decreased (all P<0.05), but RWC did not change very much in NIDDM groups. Conclusion The characteristics of CML in HT group was shown as increased AD and RWC, decreased CD and AEC, among which the increased RWC was the typical change compared with the groups of CAD and NIDDM. The damaged CML was one of the main causes for decreased coronary flow reserve and myocardial ischemia in cases of hypertensive LVH.