下肢静脉功能不全时下肢腓肠肌细胞病理生理学改变的研究

A Study on the Pathophysiologic Changes of Gastrocnemius Cell in Lower Limb Deep Venous Insufficiency

探讨腓肠肌细胞病理形态学和细胞代谢变化与下肢静脉功能不全相互关系及其临床意义 .依据血管造影和多普勒超声检查结果分为对照组 (A组 )及单纯下肢浅静脉曲张 (B组 )、原发性下肢深静脉瓣膜功能不全(C组 ) 3组 ,每组 1 0例 .分别取大腿长收肌 (对照 )和小腿腓肠肌标本检测肌肉中的SOD、NO、Na+ _K+ _ATP酶、Ca2 + _ATP酶、乳酸等各项指标 ;HE染色、ATP酶染色、SDH/COX双重染色后光镜、电镜观察 .结果显示 :A及B组肌组织结构和生化指标均正常 ,C组腓肠肌可见散在肌纤维萎缩、变性和坏死 ,炎性细胞浸润 ;同型肌纤维群化 ;COX/SDH染色可见单根或多根肌纤维酶活性增高 .肌丝间可见脂肪空泡聚集 ,部分线粒体空泡化或髓鞘样改变 .C组腓肠肌乳酸显著高于其他组别 (P <0 .0 1 ) ,而其Na_K_ATP酶、Ca2 + _ATP酶活性、NO、SOD等与其他组比较有显著下降 (P <0 .0 1 ) .表明下肢深静脉功能不全者患肢腓肠肌在肌纤维类型、超微结构和肌肉组织多项生化指标等均发生明显变化 ,推测小腿腓肠肌超微结构的病变是手术后远期效果不佳的病理基础 .如果从骨骼肌营养和抗氧化处理等角度进行治疗 。

The purpose of this study is to disclose the pathologic and cell metabolic changes of the gastrocnemius consequents on deep vein insufficiency(DVI)and its clinical significance.On the basis of angiographic and Doppler examinations,30patients were divided into group A(control),group B(simple varicosity)and group C(primary deep vein valvular insufficiency),10patients in each group.Thigh adductor longus muscle and gastrocnemius were subjected to superoxide dismutase(SOD),Nitric oxide(NO),Na + -K + -ATPase,Ca + _ ATPase and lactic acid(LD)determinations.Following HE stain,special ATPase,Cytochrome coxidase/succinate dehydrogenase(COS/SDH),samples were subjected to light and electronic microscopic examinations.The results showed that normal muscle architecture under stain of HE,ATPase and COX/SDH and normal cell metabolic changes happened in patients of group A and B.Whereas in group C,pathologic changes encountered disseminated myofibril atrophy,cell denaturation and necrosis and inflammatory cell infiltration and proliferation and dilation of interfascicular vein.ATPase stain(pH9.4)demonstrated agglomeration of the same type of myofibrils,especially for type I myofibril mass,accompanied by type II myofibril atrophy.Enchanced enzymatic activity in single or multiple myofibrils could be seen in COX/SDH stain.Swelling,myelin figure denaturation of mitochondria,disruption of the myofibrils and increased lipid droplets in gastrocnemius were apparent in group C.Reduction in SOD,NO,biochemical activity of Na + -K + -ATPase,Ca + -ATPase with increasing concentration of LD were present.All indicate that venous congestion,muscle swelling and chronic anoxia are responsible for the patho_physiologic changes in patients with DVI,such as muscle hypoxia,type II muscle atrophy,mitochondria denaturation,muscle fiber degenerat ion.All result in depletion of gastrocnemius pump function.It may be reasonable to treat DVI by nutritional and anti_oxidative drug for muscles and the function of gastrocnemius pump can be improved.