脑内不同节段小动脉硬化程度差异与脑梗死的相关性

背景外径＜300μm的阻力小动脉结构与功能改变是缺血性脑血管病的病理基础之一,然而针对不同脑区及不同外径小动脉的定量研究较少.目的探讨脑梗死后不同部位及不同外径脑小动脉硬化程度的差异.设计抽样调查.单位解放军北京军区总医院神经内科.材料实验标本均取自1980-01/2000-09解放军北京军区总医院自愿捐献的尸体解剖病例,根据临床表现、脑CT检查和尸体解剖病理检查诊断,选取动脉硬化性脑梗死死亡病例38例.非心脑血管性疾病死亡病例15例为对照组.方法标本均在死后1～3 d内取材,选取额、顶叶皮质及底节区白质组织(3块/例),制备切片.每张切片选取5个不同视野,按小动脉外径大小分为＜50 μm组,50～100 μm组及＞100 μm组.用(外径-内径)/内径,计算血管硬化程度.主要观察指标[1]脑梗死组与对照组不同外径小动脉硬化程度.[2]脑梗死组不同脑区小动脉硬化程度.结果参加实验的38例动脉硬化性脑梗死死亡病例和15例非心脑血管性疾病死亡病例标本均进入结果分析.[1]脑梗死组外径＜50 μm的小动脉硬化指数值明显高于50～100 μm组和＞100μm组[(138.55±76.67)%,(116.82±58.80)%,(78.07±32.06)%,P＜0.01],外径＞100 μm的小动脉硬化指数值与对照组较接近[(78.07±32.06)%,(46.38±13.41)%,P=0.174].[2]脑梗死组白质中＜50 μm的小动脉硬化指数值明显高于灰质[(152.86±87.83)%,(127.97±64.76)%,P＜0.05].结论动脉硬化后脑梗死患者小动脉硬化程度与其外径及位置相关,外径小或位于白质的小动脉硬化程度高.

Correlation between brain arteriolar sclerosis degree and cerebral infarction at different brain region

BACKGROUND: The structural and functional changes in resistance arteriole of external diameter ＜300 μm is one of the pathological foundations for ischemic cerebrovascular diseases, however there are few quantitative study on the arterioles of various external diameter at different brain area.OBJECTIVE: To probe the difference of arteriolar sclerosis of various external diameter at different brain area after cerebral infarction.DESIGN: Sample investigation.SETTING: Department of Nerve Internal Medicine, General Hospital of Beijing Military Area Command of Chinese PLA.SUBJECTS: Specimen was taken from donated autopsy case in General Hospital of Beijing Military Area Command of Chinese PLA from January 1980 to September 2000. According to the clinical manifestation, brain CT inspection and pathological diagnosis of autopsy, 38 cases were defined as arteriosclerosis cerebral infarction and taken as experimental group, other 15 cases with non-cardiac cerebrovascular disease were taken as controls.METHODS: specimen was obtained in 1-3 days after death from frontal and parietal cerebral cortex and basal gonglion white matters (3 pieces /case) and cut into slices. Five fields of vision were selected from each slice for microscopic observation. Arteriole was divided into ＜ 50 μm group,50-100 μm group and ＞100 μm group according to the arteriole external diameter. (External diameter- internal diameter)/internal diameter was used to assess vascular sclerosis.MAIN OUTCOME MEASURES: [1] Difference of arteriole sclerosis between corresponding external diameter cerebral infarction group and control group. [2] Arteriole sclerosis in various brain region in cerebral infarction group.RESULTS: Totally 38 experimental cases died from arteriosclerosis cerebral infarction and 15 controls died from non-cardiac cerebrovascular disease were enrolled and all data was entered the result analysis. [1] The arteriolar sclerosis index was obviously higher in ＜ 50 μm external diameter cerebral infarction group than in 50-100 μm group and ＞100 μm group[(138.55±76.67)% vs (116.82±58.80)%, (78.07±32.06)%, P ＜ 0.01], while it was approximately the same in the 100 μm external diameter group and control group [(78.07±32.06)% vs (46.38±13.41)%, P=0.174 ]. [2] In ＜ 50 μm external diameter cerebral infarction group, the arteriolar sclerosis index in white matters was significantly higher than that in gray matter [(152.86±87.83)%,(127.97±64.76)%, P ＜ 0.05 ].CONCLUSION: Arteriolar sclerosis degree is correlated with its external diameter and position in patients with cerebral infarction after arteriosclerosis, arteriole of small external diameter or in the white matter has higher arteriolesclerosis liability.