缺血性脑血管病患者颈内动脉斑块的形态学研究

Study on plaque morphology of internal carotid artery in patients with ischemic cerebrovascular disease

目的 探讨缺血性脑血管病患者和对照组颈内动脉斑块的形态学差异。方法 对 8例有缺血性脑血管病症状的死者进行尸体解剖 ,并对其颈内动脉进行连续取材 ,光镜观察斑块形态 ,并通过图像分析系统对斑块内脂质大小、斑块纤维帽厚度进行测定。同时对 8例年龄相当的无缺血性脑血管病症状的死亡病例 ,做颈内动脉对照研究。选取部分稳定及不稳定斑块进行免疫组织化学染色 ,观察二者巨噬细胞含量的差异。结果 8例缺血性脑血管病组共 12 1个颈内动脉取材块中 ,不稳定斑块占 2 1.5 % (2 6 12 1) ;而对照组 10 9个颈内动脉取材块中不稳定斑块仅占11.0 % (12 10 9)。差异有显著性意义 (P <0 .0 1)。纤维帽厚度在有症状组和无症状组分别为 (0 .3± 0 .2 )mm和(0 .5± 0 .3)mm ,差异有显著性意义 (P <0 .0 1)。免疫组织化学显示不稳定斑块中巨噬细胞数量明显多于稳定斑块。结论 缺血性脑血管病患者颈内动脉斑块破裂与血栓形成的机会增加 ,斑块脂质中心越大 ,斑块表面纤维帽越薄 ,巨噬细胞越多 ,则斑块越不稳定 ,越容易破裂导致缺血性脑血管病症状的发生。

Objective To observe the morphological difference of carotid plaques between patients with and without brain ischemia.Methods Serial sections of the carotid arteries of the 8 cases with cerebral ischaemia were taken and the morphology of the plaques was observed microscopically.The lipid core as well as the fibrous cap were measured by image analysis system.Eight cases without cerebral ischaemia served as control and were studied with the same methods. Some stable and unstable plaques were studied with immunohistochemistry to show the difference of macrophage content.Results 26(21.5% )of the 121 carotid artery plaques in the 8 cases with cerebral ischaemia were unstable plaques; while only 12(11.0%) of the 109 carotid artery plaques in the 8 control cases were unstable plaques(P<0.01).The fibrous caps of the two groups were 0.3 ±0.2 mm and 0.5±0.3 mm in thickness respectively(P<0.01). The immunohistochemistry showed that there were more macrophages in the unstable plaques than in the stable plaques.Conclusions The chances of carotid plaque rupture and thrombosis formation were increased in patients with cerebral ischemia. The larger the lipid core and the more macrophages in the plaques, the more likely the plaque rupture in cerebral ischaemia.