浅表血栓性静脉炎管壁的细胞凋亡水平变化

Changes in levels of apoptosis in walls of superficial thrombophlebitis

目的检测浅表血栓性静脉炎管壁的细胞凋亡水平变化,探讨细胞凋亡与静脉管壁扩张的相关性。方法收集大隐静脉曲张标本50例,其中浅表血栓性静脉炎(血栓组)和单纯静脉曲张标本各25例(曲张组)。正常大隐静脉标本15例(对照组)。采用末端标记法(TUNEL)、免疫荧光法、免疫组织化学法及电镜,观察细胞凋亡水平和超微结构变化。结果血栓组和曲张组管壁内膜和中膜凋亡细胞比率明显低于对照组,差异有统计学意义(P<0.01);血栓组和曲张组管壁Bcl-xl阳性蛋白呈高表达,对照组管壁Bax阳性蛋白呈高表达。电镜显示,3组凋亡细胞形态学特征为线粒体嵴模糊、髓样变、核染色质边集。结论浅表血栓性静脉炎和曲张静脉通过内源性通道引发细胞凋亡调节异常,导致静脉管壁扩张、增厚,推测其可能是静脉曲张的发病机制之一。

[Objective] To investigate the relationship between apoptosis and great saphenous varicose veins by detecting the changes in levels of apoptosis in venous walls. [Methods] Totally 50 specimens of great saphenous veins [25 specimens with superficial thrombophlebitis （thrombosis group） and 25 specimens of simple varicose veins （varicose group）] as well as 15 specimens of normal great saphenous veins （control group） were collected. Apoptosis as well as Bax and Bcl-xl protein expressions were evaluated by the TUNEL assay and immunofluorescence staining. The morphology of apoptotic cells was observed with eleetromicroscope. [Results] In the thrombosis and varicose groups, the apoptotic cell rates in the venous wails （intima and media） were significantly lower than those in the corresponding regions in the control group （P 〈 0.01）. The high expression of Bcl-xl protein was detected in the thrombosis and varicose groups, while the high expression of Bax protein was observed in the control group. Electromicroscopic observation confirmed that endothelial and smooth muscle cells in the three groups exhibited apoptotic morphologic features, such as fuzzy mitochondrial cristae, medullary changes and margination of the nuclear chromatin. [ Conclusions] Our results showed that dysregulation of apoptosis via the intrinsic pathways in varicose veins leads to the down- regulation of apoptosis, which results in wall thickening and an increase in the lumen. This may be one of the mechanisms of venous diseases.