颈动脉粥样硬化狭窄患者的斑块特征及斑块中内脏脂肪素的表达

The Characteristics of Carotid Plaque in Patients with Carotid Atherosclerotic Stenosis and The Expression of Visfatin in Carotid Plaque

目的研究颈动脉粥样硬化患者的斑块特征并探讨内脏脂肪素(visfatin)与斑块稳定性之间的关系。方法 56例颈动脉粥样硬化狭窄患者根据临床表现及发作时间分为有症状组和无症状组;HE染色及Masson染色观察斑块的病理学特征,并根据纤维帽厚度和脂质坏死核心大小将斑块分为稳定性斑块和不稳定性斑块;免疫组化染色观察2组斑块中visfatin的表达情况。结果 1有症状组不稳定性斑块的比例(67.74%)明显高于无症状组(36.00%),P<0.05。2与稳定性斑块相比,不稳定性斑块的纤维帽较薄、脂质坏死核心较大及发生出血者比例较高:(49.87±8.75)μm比(74.54±6.80)μm(P<0.001);(65.63±12.97)%比(31.81±5.13)%(P<0.001);63.33%比30.77%(P<0.05)。3不稳定性斑块visfatin表达的积分光密度值(84 165.47±9 183.12)明显高于稳定性斑块(55 694.08±4 818.57),P<0.001。结论 1斑块的不稳定性与动脉粥样硬化临床症状的发生密切相关;2纤维帽厚度、脂质坏死核心大小及出血在斑块的稳定性中发挥着重要作用;3 visfatin与动脉粥样硬化形成和斑块的不稳定性有关。

Objective To study the characteristics of carotid atherosclerotic plaque and investigate the relationship between visfatin and plaque stabilization. Methods fifty-six patients with carotid stenosis were divided into symptomatic group（n=31） and asymptomatic group（n=25） based on the clinical manifestation and onset time. All plaque specimens were stained with HE and Masson trichrome staining and studied pathologically. The plaques were grouped into stable and unstable plaques based on thickness of the fibrous cap and the area of lipid-rich core in the plaques. The expression of visfatin was detected by immunohistochemistry staining. Results 1 The proportion of unstable plaques were significantly higher in symptomatic group than in asymptomatic group（67.74% vs 36.00%, P〈0.05）. 2 Compared with stable plaques, unstable plaques had thinner fibrous cap, larger lipid necrotic core, and higher proportion of hemorrhage：（49.87±8.75） μm vs（74.54±6.80） μm（P〈0.001）,（65.63±12.97） % vs（31.81±5.13） %（P〈0.001）, and 63.33% vs 30.77%（P〈0.05）. 3 The integral optical density value of expressed visfatin in unstable plaques was significantly more than in stable plaques（84 165.47±9 183.12 vs 55 694.08±4 818.57, P〈0.001）. Conclusions The plaque destabilization is closely related to the clinical symptoms of atherosclerosis. The thickness of fibrous cap, area of lipid-rich core, and hemorrhage play an important role in the plaque stabilization. The visfatin is related to atherogenesis and plaque destabilization.