乙酰肝素酶及新生血管在人颈动脉粥样硬化斑块中的表达

Expression of heparanase and angiogenesis in human carotid atherosclerotic plaques

目的探讨乙酰肝素酶(Hpa)及新生血管在人颈动脉粥样硬化斑块中的表达特点。方法回顾性连续纳入2014年12月至2017年12月首都医科大学附属复兴医院神经外科接受颈动脉内膜切除术治疗的颈内动脉系统粥样硬化性狭窄患者55例(动脉粥样硬化组),经血管超声、CT血管成像和(或) DSA等影像学方法证实。根据美国心脏学会动脉粥样硬化组织病理学分型方法,筛选出结构清楚的晚期动脉粥样硬化斑块(Ⅳ～Ⅵ型)作为颈动脉粥样硬化斑块标本(共73个)。根据形态学分型标准,将73个颈动脉粥样硬化斑块标本分为易损斑块(42个)和移形斑块(31个)。选择同期于北京大学医学部病理学系行尸体解剖,并明确无动脉粥样硬化病变者15例为无动脉粥样硬化组(正常动脉段标本15个)。采用免疫组织化学、免疫荧光染色检测方法,分析颈动脉粥样硬化斑块内Hpa及新生血管的表达特点。结果 (1)正常颈动脉组织中无Hpa表达;颈动脉粥样硬化斑块内,Hpa阳性表达率为64. 4%(47/73)。(2)与移形斑块相比,易损斑块内Hpa阳性表达率增高[92. 9%(39/42)比25. 8%(8/31),χ~2=34. 968,P <0. 01]。(3)新生血管在颈动脉粥样硬化斑块内呈阳性表达,与移行斑块相比,易损斑块内新生血管阳性表达率更高[95. 2%(40/42)比22. 6%(7/31),χ~2=41. 060,P <0. 01]。(4)颈动脉粥样硬化斑块内,Hpa与新生血管表达主要位于斑块的纤维帽及肩部。结论 Hpa在颈动脉粥样硬化晚期病变进展过程中具有一定的作用,颈动脉粥样硬化斑块内Hpa与新生血管表达具有共区域性。

Objective To investigate the expression characteristics of heparinase(Hpa)and angiogenesis in human carotid atherosclerotic plaques.Methods Fifty-five consecutive patients with atherosclerotic stenosis in internal carotid artery system treated with carotid endarterectomy(atherosclerosis group)at the Department of Neurosurgery,Fuxing Hospital,Capital Medical University from December 2014 to December 2017 were enrolled retrospectively.They were confirmed by imaging methods,such as vascular ultrasound,CT angiography and/or DSA.According to the atherosclerotic histopathological classification method of American Heart Association,the well-defined advanced atherosclerotic plaques(typesⅣ-Ⅵ)were screened as carotid atherosclerotic plaque specimens(n=73).According to the morphological classification criteria,73 carotid atherosclerotic plaque specimens were divided into vulnerable plaques(n=42)and metastatic plaques(n=31).Autopsy was performed at the Department of Pathology,Peking University Medical School at the same time,and 15 patients without atherosclerotic lesions were identified as non-atherosclerotic group(15 normal arterial specimens).Immunohistochemistry and immunofluorescence staining were used to analyze the expression characteristics of Hpa and neovascularization in carotid atherosclerotic plaque.Results(1)There was no Hpa expression in normal arterial tissue;in the carotid atherosclerotic plaque,the positive expression rate of Hpa was 64.4%(47/73).(2)Compared with the metastatic plaques,the positive expression rate of Hpa in the vulnerable plaques increased(92.9%[39/42]vs.25.8%[8/31],χ2=34.968,P<0.01).(3)The expression of neovascularization was positive in carotid atherosclerotic plaques.Compared with the metastatic plaques,the positive expression rate of neovascularization in the vulnerable plaques was higher(95.2%[40/42]vs.22.6%[7/31],χ2=41.060,P<0.01).(4)In carotid atherosclerotic plaques,Hpa and neovascularization expression was mainly located in the fibrous cap and shoulders of the plaques.Conclusions Hpa has a certain role in the progression of advanced atherosclerotic lesions.Hpa and angiogenesis expression in carotid atherosclerotic plaques has a co-regionality.