冠状动脉粥样硬化症及其猝死的尸检病理学分析

Autopsy pathological characteristics in coronary artery disease patients with or without sudden cardiac death

目的 探讨冠状动脉粥样硬化症（CAS）及其猝死（SCD）的临床病理学特点.方法 将145例（男125例,女20例）患有CAS的尸检案例分为SCD组（38例）和非SCD组（107例）,比较二者在年龄、CAS多支病变、病变分期（其中脂纹期27例、纤维斑块期55例和粥样斑块期63例）、复合性病变、管腔狭窄程度以及合并疾病等方面的差异性.结果 （1） SCD组平均年龄为（55.3 ±14.5）岁,高于非SCD组的（48.5± 13.3）岁,差异有统计学意义（t二2.63,P＜0.01）.（2）CAS病变分期与管腔狭窄程度分级呈正相关性（r真=0.79,P＜0.01）.（3） SCD组38例中CAS多支冠状动脉病变、病变为粥样斑块期、复合性病变、管腔狭窄Ⅲ～Ⅳ级和陈旧性心肌梗死、脑底动脉硬化率分别为60.5％（23例）、84.2％（32例）、63.2％（24例）、86.8％（33例）、36.8％（14例）和34.2％（13例）,非SCD组107例中则分别为25.2％（27例）、29.0％（31例）、18.7％（20例）、19.6％（21例）、3.7％（4例）和6.5％（7例）,两两比较差异均有统计学意义（P均＜0.01）.结论 CAS粥样斑块期及管腔狭窄Ⅲ～Ⅳ级是SCD的病变基础,CAS累及多支及复合性病变、陈旧性心肌梗死和脑底动脉硬化则可能是SCD风险增加的病理学因素.

Objective To compare clinicopathological characteristics of coronary artery disease （CAD） patients with or without sudden coronary death（SCD）.Methods A total of 145 autopsy cases with CAD were divided into SCD group（38 cases）and non-SCD group （107 cases）.The difference on age,number of diseased coronary vessel,coronary athemsclerotic stage （fatty streak stage,fibrous plaque stage and atheromatous plaque stage）,composite lesions of coronary artery,grade of stenosis severity,acute myocardial infarction,old myocardial infarction,hypertensive cardiomyopathy,myocardial fatty infiltration and arteriosclerosis of the arteries on the base of the brain were compared between SCD group and non-SCD group.Results （1） Patients were older in SCD group than in non-SCD group [（55.3 ± 14.5） years vs.（48.5 ± 13.3） years,P 〈 0.01].（2） There was a significant positive correlation between coronary atherosclerotic stage and grade of coronary stenosis severity （rs =0.79,P 〈 0.01）.（3） The rate of multiple vessel disease,coronary atherosclerotic stage,composite lesions of coronary artery,grade Ⅲ-Ⅳ coronary artery stenosis,old myocardial infarction and arteriosclerosis of the arteries on the base of the brain were 60.5% （23/38）,84.2% （32/38）,63.2% （24/38）,86.8% （33/38）,36.8% （14/38） and 34.2% （13/ 38）,respectively in SCD group,which were significantly higher than those in non-SCD group [25.2% （27/ 107）,29.0% （31/107）,18.7% （20/107）,19.6% （21/107）,3.7% （4/107） and 6.5% （7/107）,respectively,all P 〈 0.01].Conclusion Coronary artery atherosclerotic lesion is severer and patients are older in SCD patients than in non-SCD patients in this coronary artery disease patient cohort.