股动脉粥样硬化的病理学特点探讨

目的通过与冠状动脉、颈总动脉粥样硬化比较,探讨股动脉粥样硬化的病理学特点。方法收集解放军总医院老年尸体解剖病例15例,将每例之两侧股动脉、两侧颈总动脉、左冠状动脉前降支进行连续取材,常规病理检查,选取部分节段行平滑肌肌动蛋白、CD68、bax免疫组织化学SP法染色。结果股动脉粥样硬化与冠状动脉粥样硬化在病变类型、斑块中平滑肌细胞、巨噬细胞的分布方面基本相同。但股动脉粥样硬化的范围较小、狭窄程度较轻,其斑块中的平滑肌细胞相对多,巨噬细胞相对少;bax在巨噬细胞的表达多,在平滑肌细胞的表达少。股动脉粥样硬化与颈动脉粥样硬化的病理学特点相似。结论股动脉粥样硬化与冠状动脉粥样硬化病理特点大体相同,但在某些量化指标上存在差异。     

Human atherosclerosis. II. Immunocytochemical analysis of the cellular composition of human atherosclerotic lesions.

The authors have performed immunocytochemical investigations of the distribution of various cell types in human atherosclerotic plaques using monoclonal antibodies specific to smooth muscle cells (CGA7 [Gown et al, J Cell Biol 1985, 100:807-813] and HHF35 [Tsukada et al, Am J Pathol (In press)] ); lymphocytes (T200 antigen); endothelial cells (Factor VIII and the Ulex europeus agglutinin); and macrophages, the latter with a new macrophage-specific antibody HAM56. All studies were performed on methanol-Carnoy's-fixed, paraffin-embedded tissues. In areas of grossly normal aorta, significant numbers of macrophages were noted within areas of diffuse intimal thickening. The cellular composition of the following three types of raised lesions were analyzed: fibro-fatty lesions, which, despite their gross appearance, consistent with fibrous plaques, were composed almost exclusively of macrophages and lymphocytes and almost devoid of smooth muscle cells; fibrous plaques, which were predominantly composed of smooth muscle cells displaying considerable morphologic heterogeneity and an admixture of blood-borne cells; advanced plaques, which were characterized by complex layers of smooth muscle cells and macrophages with considerable variation from region to region. Also noted were foci of medial and even intimal vascularization subjacent to the more advanced plaques. These studies demonstrate the application of monoclonal antibody technology to the study of the cellular composition of human atherosclerotic lesions.     

Human atherosclerosis. III. Immunocytochemical analysis of the cell composition of lesions of young adults.

There have been only limited immunocytochemical studies of the cell composition of the early lesions of human atherosclerosis, and none that incorporate a comprehensive panel of antibodies to various cell types and subsets. The authors thus performed a prospective study of 27 lesions from 16 different individuals ranging in age from 15 to 34 years. These were all lesions that appeared grossly as slightly raised, yellow fatty streaks in the posterior ascending aorta, but on histologic examination had varying degrees of round-cell, spindle-cell, and foam-cell accumulation. Using a panel of antibodies, including monoclonal antibodies specific for smooth muscle cells [HHF35], human macrophages [HAM56], endothelial cells [monoclonal antibodies to F. VIII related antigen], lymphocytes [anti-CD45, anti-CD20, anti-CD45RO, anti-T-cell receptor], it was revealed that the predominant cell type in these early lesions was the smooth muscle cell, including the vast majority of the foam cells, which tended to appear in the deeper regions of the lesions. There were variable numbers of smooth muscle cells and lymphocytes; the latter were exclusively T cells. It is concluded that in atherosclerotic lesions of young adults, which may represent various stages of fatty streak formation and advanced fatty streaks, smooth muscle cell accumulation may be an early event.     

Flow-mediated dilatation in the superficial femoral artery is nitric oxide mediated in humans

Flow-mediated dilatation (FMD) of the brachial and radial arteries is an important research tool for assessment of endothelial function in vivo , and is nitric oxide (NO) dependent. The leg skeletal muscle vascular bed is an important territory for studies in exercise physiology. However, the role of endothelial NO in the FMD response of lower limb arteries has never been investigated. The purpose of this study was to examine the contribution of NO to FMD in the superficial femoral artery in healthy subjects. Since physical inactivity may affect endothelial function, and therefore NO availability, spinal cord-injured (SCI) individuals were included as a model of extreme deconditioning. In eight healthy men (34 ± 13 years) and six SCI individuals (37 ± 10 years), the 5 min FMD response in the superficial femoral artery was assessed by echo-Doppler, both during infusion of saline and during infusion of the NO synthase blocker N ^G-monomethyl- l -arginine ( l -NMMA). In a subset of the controls ( n = 6), the 10 min FMD response was also examined using the same procedure. The 5 min FMD response in controls (4.2 ± 0.3%) was significantly diminished during l -NMMA infusion (1.0 ± 0.2%, P < 0.001). In SCI, l -NMMA also significantly decreased the FMD response (from 8.2 ± 0.4% during saline to 2.4 ± 0.5% during l -NMMA infusion). The hyperaemic flow response during the first 45 s after cuff deflation was lower in both groups during infusion of l -NMMA, but the effect of l -NMMA on FMD persisted in both groups after correction for the shear stress stimulus. The 10 min FMD was not affected by l -NMMA (saline: 5.4 ± 1.6%, l -NMMA: 5.6 ± 1.5%). Superficial femoral artery FMD in response to distal arterial occlusion for a period of 5 min is predominantly mediated by NO in healthy men and in the extremely deconditioned legs of SCI individuals.     

Significance of the velocity impulse response and cross-correlation of the femoral and popliteal blood-velocity/time waveforms in disease of the superficial femoral artery

The velocity impulse response is calculated from blood-velocity/time waveforms recorded transcutaneously using ultrasonic Doppler-shift flow-velocity meters. The impulse response and crosscorrelation of the input and output waveforms of a segment of diseased superficial femoral artery provide information about the state of the collateral circulation which may be clinically useful. These signal-analysis techniques are applied to five cases of arterial disease, and the results are discussed under three headings: first, the clinical significance of the absolute values of the impulse response and crosscorrelation functions; secondly, the significance of the initial peaks of the impulse response and the crosscorrelation functions; and thirdly, the importance of the overall shape of those functions in differentiating between the types of collateral circulation.     

Human atherosclerosis. IV. Immunocytochemical analysis of cell activation and proliferation in lesions of young adults.

The accumulation of smooth muscle cells is a major phenomenon associated with the pathogenesis of lesions of atherosclerosis. Smooth muscle cell proliferation in response to the release of growth factors from neighboring cells, both smooth muscle and macrophages, is one mechanism postulated to account for the increasing numbers of smooth muscle cells as atherosclerotic lesions progress. Indeed, we recently demonstrated the B chain of platelet-derived growth factor (PDGF-B), a potent smooth muscle mitogen, within macrophages in monkey and human lesions of atherosclerosis. To further test the hypothesis that smooth muscle proliferation and/or activation (eg, expression of major histocompatibility complex proteins) plays a role in the early development of these lesions, we applied antibodies to PDGF-B, HLA-DR (a marker of cell activation), and proliferating-associated marker) on a series of early human atherosclerotic lesions from young adults in conjunction with cell-type-specific antibodies. Smooth muscle cells had previously been demonstrated to comprise a major fraction of the cell population in these lesions. In a continuing study of early and intermediate lesions of individuals ranging in age from 15 to 34 years, PDGF-B was detected within macrophages in 2 of 15 lesions. There was no evidence of HLA-DR expression by the smooth muscle cell population in any of the lesions. PCNA-positive cells comprised less than 2% of the cells in the lesions, and the majority of these were blood-borne cells (macrophages and/or lymphocytes), although a small fraction of the PCNA-positive cells were identified as smooth muscle. Concurrent PCNA and 5'-bromodeoxyuridine studies of peripheral blood monocytes demonstrated the presence of significant numbers of cells positive for these proliferation-related markers. It is concluded that the growth factor PDGF-B may have a role in regulating cell proliferation in early human fatty streaks, but the number of proliferating smooth muscle cells is relatively small, and there is no evidence of smooth muscle cell activation, as judged by HLA-DR positivity, in these lesions.     

腹壁浅动脉与旋髂浅动脉共干起于股深动脉1例

腹壁浅动脉与旋髂浅动脉变异类型较多,两组血管可分别起源于股动脉或两者共干后起于股动脉,或者两组血管发自股深动脉、旋股动脉及会阴动脉,或者两组血管中其中一组缺损等类型.如果为共干的血管或一组血管缺如而另一组血管代偿性增大者,其外径一般较粗[1,2].两者共干起源于股深动脉的情况临床报道少见,作者在解剖一具男尸时发现一侧此类变异,报道如下.     

Tortuosity and atherosclerosis in the femoral artery: What is cause and what is effect?

Earlier studies have demonstrated a correlation between tortuosity and atherosclerosis in the femoral artery. One conceivable explanation is that atherosclerosis causes an elongation of the artery, resulting in vessel tortuosity; another is that blood flow phenomena (such as flow separation) due to the vessel geometry may affect the progression of atherosclerosis. To determine which of these hypotheses is most likely, a group of 232 hyperlipidemic patients was followed with angiography for 3 years during lipid-lowering treatment. After digitization of the films, a tortuosity value and an atherosclerosis measure (edge roughness) were computed. In the group with lower tortuosity values, there was a significant (p<0.0001) decrease in edge roughness, but not in the group with a higher tortuosity values. On the other hand, neither the group with higher edge roughness values nor that with lower edge roughness values displayed a significant change in tortuosity. When tortuosity, roughness, and treatment were studied simultaneously, only the effect of tortuosity on roughness change was significant. These findings are more consistent with tortuosity influencing the development of atherosclerosis than with its being a consequence of atherosclerosis.     

Morphologic and morphometric characteristics of the femoral head in experimental necrosis and after incomplete occlusion of the femoral artery

Partial occlusion (by 70-80%) of the femoral artery (FA) below its bifurcation with the deep femoral one was created in 15 dogs 6 months after modeling of aseptic necrosis of femoral head (FH). The dynamics of local circulation was evaluated using the methods of hydrogen clearance, angiography, flowmetry, polarography and mingography. FA and neighboring vessels as well as FH bone tissue were studied using histological, histochemical and morphometric methods. It was found that partial occlusion of FA below its bifurcation with the deep femoral branch resulted after 180-240 days in a redistribution of blood flow in favor of the latter along with a formation of collateral vessel widening as well as in the change in the circulation vector in the direction of the hip joint. This contributed to FH revascularization after modeling of its traumatic aseptic necrosis. The results of the morphological analysis indicate the activation of osteogenesis and gradual replacement of the necrotic area in FH with a newly formed osseous tissue and are suggestive of possible application of this method for clinical use.     

Morphologic characteristics of naturally occurring atherosclerosis in the brachiocephalic artery of the pigeon

Endothelial characteristics and the macrophage foam cell nature of early naturally occurring lesions in the aorta and coronaries of the pigeon have been well characterized. However, the characteristics of pigeon atherosclerosis at other vascular sites have not been extensively studied. The present study was designed to compare atherosclerosis in the brachiocephalic artery with that in the coronaries and aorta. Forty-six White Carneau (WC) pigeons (26 female, 20 male) ranging in age from 2.5 to 7 years were necropsied after fixation under deep anesthesia by perfusion at 160 mm Hg with buffered glutaraldehyde. Arteries stained with Sudan IV for gross evaluation were subsequently processed for SEM and TEM. The occurrence of sudanophilia in the proximal brachiocephalic artery was greater in females (22/26) than in male (2/20). The endothelium, as studied by SEM, was intact over all normal and sudanophilic areas. Cell morphology varied with location in the vessel and gradually changed from polygonally shaped cells with prominent margins and protruding nuclei in the proximal brachiocephalic artery to elongated, flattened cells in distal regions. These regional differences were consistently observed, and did not correlate with age, gender, or areas of lipid accumulation. Unlike lesions in the coronary arteries and at the celiac bifurcation of the aorta, a relative paucity of white blood cells over diffuse sudanophilic areas was observed. This lack of adherent monocytes correlated with lesion ultrastructure. Connective tissue in the intima of the sudanophilic brachiocephalic arteries was disorganized, reflecting both an increase in matrix components and the presence of massive pools of extracellular lipid. Intracellular lipid was minimal and when present was confined to random droplets in the cytoplasm of intimal smooth muscle cells. Monocyte-derived foam cells, characteristic to other vascular beds, were absent from the brachiocephalic artery lesions. These results document differential lesion composition in the WC pigeons and suggest a gender-related susceptibility for brachiocephalic artery atherosclerosis in pigeons.     

Effect of propranolol on the tone of collateral arteries in patients with occlusion of the superficial femoral artery

The effect of administration of 0.5 mg propranolol into the femoral artery in eight patients with lower limb ischaemia and superficial femoral artery occlusion on collateral arterial resistance was studied in supine and tilted head-up position. Mean blood pressures were recorded directly from the femoral and popliteal artery and femoral blood flow was measured by an indicator dilution technique. After beta-receptor blockade in the supine position the collateral arterial resistance increased by 7 +/- 2%, femoral blood flow decreased 10 +/- 4%, and popliteal artery pressure increased by 4 mmHg (8 +/- 3%). During head-up tilt there was no change in femoral blood flow and collateral arterial resistance after propranolol. The peripheral vasoconstrictor effect of propranolol, therefore, seems not to be harmful to patients with vascular disease.     

Human femoral artery and estimated muscle capillary blood flow kinetics following the onset of exercise

The purpose of this study was to compare the kinetics of estimated capillary blood flow (Qcap) to those of femoral artery blood flow (QFA) and estimated muscle oxygen uptake (VO2m). Nine healthy subjects performed a series of transitions from rest to moderate (below estimated lactate threshold, 6 min bouts) knee extension exercise. Pulmonary oxygen uptake (VO2) was measured breath by breath, (QFA) was measured continuously using Doppler ultrasound, and deoxyhaemoglobin ([HHb]) was estimated by near-infrared spectroscopy over the rectus femoris throughout the tests. The time course of (Qcap) was estimated by rearranging the Fick equation (i.e. Qcap = VO2m/(a-v)O2), (arterio - venous O2 difference) using the primary component of VO2 to represent VO2m and [HHb] as a surrogate for (a - v)O2. The overall kinetics of QFA (mean response time, MRT, 13.7 +/- 7.0 s), VO2m (tau, 27.8 +/- 9.0 s) and Qcap (MRT, 41.4 +/- 19.0 s) were significantly (P < 0.05) different from each other. We conclude that for moderate intensity knee extension exercise, conduit artery blood flow (QFA) kinetics may not be a reasonable approximation of blood flow kinetics in the microcirculation (Qcap), the site of gas exchange. This temporal dissociation suggests that blood flow may be controlled differently at the conduit artery level than in the microcirculation.     

Human T lymphotropic virus type I associated myelopathy with pulmonary and cutaneous lesions.

A necropsy case of human T lymphotropic virus I (HTLV-I) associated myelopathy (HAM) in a 64 year old man with serological and genetical confirmation of HTLV-I infection is reported. The spinal cord, lung, and skin were mainly affected. Severe degeneration had occurred in the spinal cord, not only in the lateral columns but also in the anterior and posterior columns. The degenerate lesions showed proliferation of capillaries, loss of myelin and axon, and perivascular and parenchymal infiltration with T lymphocytes and foamy macrophages in the white matter. T lymphocytes had infiltrated the lung and there was vascular proliferation in the peribronchus. OPD4 positive cells predominated in the lung. The patient also had erythrodermia where dense and bandlike HTLV-I infected lymphoid cell infiltration was observed, with mild atypia and epidermotropism. HTLV-I may cause multiorganic inflammatory disorders, although the definitive role of HTLV-I in the pathogenesis is still unknown.     

Effector Cell Sensitivity to Sugar Moieties. I. Inhibition of Human Natural Killer Cell Activity by Monosaccharides

Human natural killer (NK) cells recognize multiple target antigens. The ligands (antigens) involved in the effector-target cell interaction have not been extensively identified. In the present study, assays of NK activity in the presence of a panel of monosaccharides demonstrated inhibition of cytolysis in a dose-response fashion. We propose that NK cell activity involves the recognition of carbohydrate structures on target cells via receptors on the effector cell surface.     

B细胞活化基因的研究Ⅰ．人活化B细胞cDNA文库的构建

本文报导以人活化Ｂ淋巴细胞的３Ｄ５细胞的ｍＲＮＡ为模板，逆转录合成ｃＤＮＡ的第一链：按常规的自身引物法，以合成的第一链为模板合成ｃＤＮＡ第、二链；以及λｇｔ１１Ｓｆｉ－Ｎｏｔ噬菌体为载体，定向插入构建了人活化Ｂ细胞。ＤＮＡ表达文库。该文库的大小为２．５×１０６ｐｆｕ，插入片段长度大于１ｋｂ；用抗ＣＤ７１及ＣＤ９８单克隆抗体为探针，对所构建的文库进行筛选，均获得了阳性克隆，ＣＤ７１及ＣＤ９８均为人Ｂ细胞活化时才得以表达的分化抗原，从而证明，新构建的ｃＤＮＡ文库是人活化Ｂ细胞的ｃＤＮＡ表达文库。     

股深动脉及旋股外侧动脉起始行程异常1例

有关股深动脉的行程变异报道较少，仅见陈子华、刘万胜报道2例，笔者在解剖成年一男性标本时见其右侧股深动脉行程特殊,报道如下：