Stanford A型主动脉夹层患者主动脉壁中簇集素的表达水平及其临床意义

Expression level of clusterin in aortic wall of patients with Stanford type A aortic dissection and its clinical significance

目的探讨Stanford A型主动脉夹层患者主动脉壁中簇集素(Clusterin)的表达水平及其临床意义。方法选择13例Stanford A型主动脉夹层患者为病例组,9例扩张型心肌病或冠心病患者为对照组。收集两组患者的主动脉壁标本,测量病例组患者各段主动脉直径。通过苏木精-伊红染色及EVG染色观察两组组织形态和弹力纤维断裂情况;检测两组标本中Clusterin mRNA和蛋白的表达水平;分析病例组患者Clusterin mRNA表达水平与各段主动脉直径的相关性。结果与对照组比较,病例组主动脉壁中平滑肌细胞明显减少、弹力纤维断裂增多,Clusterin mRNA和蛋白的相对表达水平均升高(均P<0.05)。免疫组化染色显示,Clusterin主要定位于细胞质及细胞外基质中,病例组主动脉壁中Clusterin的相对表达水平亦高于对照组(均P<0.05)。病例组患者Clusterin基因的相对表达水平与降主动脉、腹腔干处主动脉直径均呈正相关(均P<0.05)。结论Stanford A型主动脉夹层患者主动脉壁中Clusterin的基因和蛋白水平均升高;Clusterin表达水平上调可能与主动脉夹层的发生和发展均相关。

Objective To investigate the expression level of clusterin in the aortic wall of patients with Stanford type A aortic dissection and its clinical significance.Methods Thirteen patients with Stanford type A aortic dissection were selected as case group,and nine patients with dilated cardiomyopathy or coronary heart disease were selected as control group.The aortic wall specimens of the two groups were collected,and the aortic diameter of each segment of patients in the case group was measured.Histomorphological features and elastic fiber breakage were observed in the two groups by hematoxylin-eosin staining and elastic-Van Gieson(EVG)staining;the expression levels of clusterin mRNA and protein in specimens of the two groups were detected;the correlation of the expression level of clusterin mRNA with aortic diameter of each segment was analyzed in the case group.Results Compared with the control group,the case group displayed significantly reduced smooth muscle cells in the aortic wall,increased elastic fiber breakage,and elevated relative expression levels of clusterin mRNA and protein(all P<0.05).Immunohistochemical staining revealed that clusterin was commonly located in the cytoplasm and extracellular matrix,the relative expression level of clusterin in the aortic wall in the case group was higher than that in the control group(all P<0.05).In the case group,the relative expression level of clusterin gene positively correlated with the diameters of descending aorta and celiac trunk aorta(all P<0.05).Conclusion Patients with Stanford type A aortic dissection experience elevated mRNA and protein levels of clusterin in the aortic wall;up-regulation of clusterin expression level may correlate with the development and progression of aortic dissection.