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目的探讨颈内动脉粥样硬化易损斑块内炎细胞、平滑肌细胞和新生血管的病理改变规律。方法 6例男性患者,年龄66～73岁,5例有高血压病史,均无高脂血症,均有颈内动脉系统缺血性脑卒中症状,数字减影血管造影或磁共振血管成像检查证实相应侧颈内动脉血管狭窄程度超过70%。对颈内动脉内膜剥脱的血管标本横断面行常规病理和免疫组织化学染色,后者检查第Ⅷ因子、血管内皮细胞黏附分子-1(VCAM-1)、内皮细胞一氧化氮合酶(eNOS)、α-平滑肌肌动蛋白(α-SMA)、核细胞增殖抗原(PCNA)以及 CD_3、CD_(45)RO 和 CD_(20)。结果斑块内可见坏死、出血和大量脂质沉积,斑块的纤维帽和肩部出现单核细胞和 CD_3、CD_(45)RO 阳性 T-淋巴细胞浸润,局部出现新生毛细血管,毛细血管内皮细胞 VCAM-1和 eNOS 表达阴性。炎细胞浸润部位的平滑肌细胞α-SMA 表达阴性或弱阳性,PCNA 染色阳性。结论颈内动脉易损性粥样硬化斑块内灶性炎细胞浸润部位出现的新生平滑肌细胞以及毛细血管存在功能缺陷,是导致斑块易损重要原因之一。
Objective To investigate the pathological changes of inflammatory cells, smooth muscle cells and neovascularization in vulnerable plaques in atherosclerotic internal carotid arteries. Methods Six male patients, aged from 66 to 73 years and 5 with history of hypertension, were all free of hyperlipidemia. They all had carotid artery ischemic stroke symptoms, digital subtraction angiography or magnetic resonance angiography Confirmed that the corresponding degree of lateral carotid artery stenosis more than 70%. The cross-sections of vascular specimens of internal carotid endarterectomy were routinely examined by histopathology and immunohistochemistry, and the latter were examined for factor Ⅷ, vascular endothelial cell adhesion molecule-1 (VCAM-1), endothelial nitric oxide synthase (eNOS) (Α-SMA), proliferating cell nuclear antigen (PCNA) and CD_3, CD_ (45) RO and CD_ (20). Results Necrosis, hemorrhage and massive lipid deposition were found in the plaque. Mononuclear cells and CD_3 and CD_ (45) RO positive T-lymphocyte infiltration were observed in the fibrous cap and shoulder of the plaque. Localized capillaries and capillary endothelium Cells were negative for VCAM-1 and eNOS expression. Smooth muscle cell α-SMA expression in inflammatory cell infiltration sites was negative or weakly positive, and PCNA staining was positive. Conclusion Neonatal smooth muscle cells and capillaries present in the infiltration of focal inflammatory cells in the carotid artery vulnerable atherosclerotic plaque are one of the important causes of plaque vulnerability.