缺血性脑血管病患者颈内动脉狭窄程度的观察

The Observation of Stenosis of Inner Carotid Artery in Patients with Cerebral Ischaemia

通过尸检材料对缺血性脑血管病病人颈内动脉进行研究 ,探讨颈内动脉狭窄程度和斑块内脂质含量与缺血性脑血管病发生的关系。 10例脑血管病病人生前均有缺血性脑血管病病史 ,死后尸检将颈内动脉颅外段完整剥离 ,固定后每隔 4mm取材并切片 ,然后光镜观察并通过计算机图象分析测定管腔的横截面积和斑块内脂质坏死中心的面积。 10例对照组病人生前均无缺血性脑血管病病史 ,研究方法和测量指标同上。结果发现 ,10例缺血性脑血管病组颈内动脉共 15 1个组织块中 ,管腔最大横截面积为 6 .2mm2 ,最小为 3.2mm2 ,平均为 4 .7± 0 .3mm2 。而对照组 134个组织块中 ,管腔最大横截面积为 6 .5mm2 ,最小面积为 3.6mm2 ,平均 4 .8± 0 .4mm2 ,两组比较无显著性差异。斑块内脂质坏死中心的平均面积在有症状组和对照组分别为 3.4± 0 .4mm2 和 1.8± 0 .2mm2 ,差异显著(P <0 .0 1)。另外 ,有症状组 11个斑块表面可见血栓 ,而对照组无血栓形成。结果表明 :缺血性脑血管病病人颈内动脉狭窄程度与对照组比较无明显差别 ,但斑块内脂质坏死中心却明显比对照组大 ,提示狭窄程度可能并非脑缺血症状的主要原因。斑块脂质坏死中心的大小可能起重要作用。

Aim To demonstrate the relationship between stenosis degree as well as plaque morphology and cerebral ischemia. Methods The inner carotid arteries of 10 patients with cerebral ischemia before death were removed en block in autopsy. After fixation, the arteries were serially cut into blocks in an interval of 4 mm and HE sections were made from every block. The HE sections were microscopically observed and the lumen area and lipid core area were measured through computer image analysis system. 10 control cases without cerebral ischemia before death were also studied, the study method and measured parameters were similar to the cerebral ischemia groups. Results Among the total 151 blocks in cerebral ischemia group, the lumen area was 6.2 mm 2 in maximum and 3.2 mm 2 in minimum, the average was 4.7±0.3 mm 2. In control group, the maximum and mimimum lumen area was 6.5 and 3.6 mm 2, with an average of 4.8±0.4 mm 2. There was no significant difference between the two groups. While the average lipid core area in cerebral ischemia group and control group was 3.4±0.4 and 1.8±0.2 mm 2 respectively. The difference was significant (P<0.01). In addition, 11 thromboli were found in the cerebral ischemia group, but no thrombus was found in the control group. Conclusion there was no significant difference of stenosis between cerebral ischemia and control groups, but the lipid core area in cerebral ischemia group was larger than that of control group. The stenosis degree may not take a more great role in the occurrence of cerebral ischemia than the lipid core size does.