【作者】 刘博；

【导师】 宋京郁；

【作者基本信息】 延边大学 ， 病理与病理生理学， 2010， 硕士

【摘要】 目的探讨CD68、α-SMA在老年人冠状动脉粥样硬化(atherosclerosis, As)病变和弥漫性内膜增厚(diffuse intimal thickening, DIT)中的表达及其与冠状As病变类型、管腔狭窄之间的关系及意义。方法选用53例尸检病例的312块冠状动脉组织标本。光镜下诊断DIT和冠状As病变及其类型,用免疫组化和Scion图像软件系统,检测和计算冠状As病变中CD68-阳性巨噬细胞,α-SMA阳.性面积%,冠状动脉管腔狭窄程度面积%、脂质坏死核心(necrotic core, NC)和钙化基质面积%。结果①在老年人冠状As病变类型和DIT中,40%(124/312)为DIT,5%(16/312)为Ⅰ型,10%(31/312)为Ⅱ型,21%(66/312)为Ⅲ型,4%(14/312)为Ⅳ型,18%(55/312)为V型和2%(6/312)为Ⅵ型；②脂质NC面积%在高胆固醇组明显大于正常胆固醇组(P<0.05),而钙化基质面积%在早期病变(Ⅰ-Ⅲ型)和进展期病变(Ⅳ-Ⅵ型)之间有显著性差异(P<0.05)；③冠状As病变CD68-阳性巨噬细胞随着冠状As病变进展和管腔狭窄程度的加重而增多,分别呈正相关(r=0.351,r=0.197,P<0.01),CD68-阳性巨噬细胞数在早期和进展期病变之间有显著性差异(P<0.01),在冠状AsⅣ型病变中,CD68-阳性巨噬细胞主要分布在斑块的肩部区；④冠状As病变内膜α-SMA阳性面积%随着冠状As病变进展和管腔狭窄程度的加重而减少,分别呈负相关(r=-0.494,r=-0.362,P<0.01),并在早期和进展期病变之间有显著性差异(P<0.05)；⑤CD68-阳性巨噬细胞、α-SMA阳性面积%在病变类型、管腔狭窄程度之间以及正常胆固醇和高胆固醇组之间有显著性差异(P<0.05)。结论老年人冠状As病变内膜CD68阳.性巨噬细胞数增多及α-SMA阳性面积%减少始终始发和加重老年人冠状As病变的进展,大量巨噬细胞在肩部区浸润和脂质NC的增大与冠状As病变进展、不稳定斑块破裂及并发症的发生有关,高胆固醇促进冠状As病变VSMC的凋亡和／或死亡,VSMC主要由中膜迁移入内膜并增殖引起适应性冠状动脉DIT。更多还原

【Abstract】 Objective To study the expression and significance of CD68,α-SMA in coronary ahtherosclerotic lesion and diffuse intimal thickening(DIT) of the aged, and the correlation among the expression of CD68, a-SMA and the lesion types of coronary atherosclerosis, the degree of luminal stenosis.Methods 312 of coronary artery tissue samples were selected in 53 cases of autopsy. Using light microscope with HE staining, the DIT, coronary atherosclerotic lesion and its types were diagnosed, and Using immunohistochemistry and the Scion image software systems, it was detected and counted in the coronary atherosclerotic lesion and DIT that CD68-positive macrophages, area percentage of lumen stenosis, lipid necrotic core(NC) and calcifying matrix.Results①There were 40%(124/312) of the DIT,5%(16/312) of typeⅠ,10%(31/312) of typeⅡ,21%(66/312) of typeⅢ,4%(14/312) of typeⅣ,18%(55/312) of typeV and 2%(6/312) of type VI in the atherosclerotic lesion types and DIT;②Area percentage of lipid NC was significantly greater in the high cholesterol group than in the normal cholesterol group(P<0.05), and area percentage of calcifying matrix was significant difference between early lesions(typeⅠ-Ⅲ) and advanced lesions(typeⅣ-Ⅵ,P<0.05);③CD68-positive macrophages in coronary atherosclerotic lesions were increased with progress of coronary atherosclerotic lesions and aggravation of luminal stenosis with positive correlation(r=0.351, r=0.197, P<0.01), but percentage of a-SMA-positive area were decreased with negative correlation(r=-0.494, r=-0.362, P<0.01), respectively, and CD68-positive macrophages and% of a-SMA-positive area had significant differences among lesion types, and degree of luminal stenosis as well as between normal cholesterol and high cholesterol groups(P<0.05).Conclusions Increased infiltration of CD68-positive macrophages and decreased percentage of a-SMA-positive area in coronary atherosclerotic lesions all along initiates and aggravates the coronary atherosclerotic lesions, and a large number of macrophages mainly infiltrated in the shoulder area and increased lipid NC of plaque are associated with progress of coronary atherosclerotic lesions, unstable plaque rupture, the occurrence of complications in coronary atherosclerosis, and hypercholesterolemia contributes to the apoptosis and/or necrosis of VSMC of coronary atherosclerotic lesions, and the VSMC mainly migrate into the intima from tunica media and proliferation to result in DIT of coronary artery.更多还原