阻塞性睡眠呼吸暂停低通气综合征患者腭咽肌组织病理学观察

目的 探讨腭咽肌的组织病理学变化在阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apneahypopnea syndrome,OSAHS)发病中的作用.方法 取OSAHS腭咽肌组织21例,以无OSAHS的尸检腭咽肌组织2例作对照,进行HE染色、Masson染色及免疫组化染色,观察其肌肉、血管、神经的组织病理学特点.10例腭咽部软组织进行透射电镜观察,研究腭咽肌肌纤维、血管神经的超微结构下组织病理学变化变化特点,分析它们之间的关系及其在OSAHS形成中的作用.结果 HE染色可见21例腭咽肌组织中肌纤维全部都有不同程度的变性.免疫组化染色见肌纤维Myosin表达减少.透射电镜下见10例肌膜下及肌纤维间的线粒体均有不同程度的肿胀变性,8例有不同程度的肌纤维溶解、肌浆管扩张.4例Z带排列不规则呈锯齿状排列,有2例Z线及H带消失,肌节结构消失,肌原纤维排列紊乱,呈线团状,肌丝溶解,其周围有变性的线粒体,细胞核固缩,胞浆内糖原稀少.对照组结构正常.结论腭咽部扩大肌是腭咽部软组织起支架作用和调节维持气道的重要成分,腭咽部扩大肌的病理性结构改变,是引起OSAHS的主要因素之一.

Histopathological study of pharyngopalatinus in patients with obstructive sleep apnea hypopnea syndrome

OBJECTIVE To study the histopath-ological changes of pharyngopalatinus in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) . METHODS Pharyngopalatinus specimens from 21 OSAHS patients and 2 non-OSAHS adult cadavers were acquired. Sections were stained with HE, Masson and immunohistochemistry methods. Ten specimens from OSAHS patients were studied with transmission electron microscope (TEM) . RESULTS The pharyngopalatinus from OSAHS patients showed degeneration in different extent. The expression of Myosin was decreased in immunohistochemistry staining. In TEM, the mitochondria under the endomysium and between the endomysium showed hydropic degeneration in 10 cases. There were 8 cases with muscle lysis and sarcoplasm tube expansion. In 4 cases, the Z lines of the muscle were arranged to be serrated. In 2 cases, the Z lines, H zones and the structures of sarcomeres were disappeared, the myofibrilla were disorganized, similar to coiled mass, the myofilaments were dissolved with degenerated mitochondria surrounded, and the nuclei became pyknosis with little glycogen in cytoplasm. The myelin sheaths of the motor nerve were loosed and regional edema in 2 cases. All the changes above were not been seen in the normal control. CONCLUSION Pharyngopalatinus is important supporting structure to adjust and maintain upper airways. The pathological changes of pharyngopalatinus may be one of the major factors causing OSAHS.