细胞凋亡在下肢静脉曲张发生机理中的作用

目的　探讨细胞凋亡和血管重塑(remodeling)在静脉曲张发生机理中的作用。方法　采用凋亡细胞原位检测(TUNEL)法，V.G.胶原纤维染色，静脉图像分析和电镜形态学等方法研究83例慢性静脉功能不全(CVI)和10例对照组。结果　①曲张静脉囊性扩张型与非囊性扩张型和对照组比较，内膜内皮细胞(ECs)、平滑肌细胞(SMC)和中膜SMC凋亡及凋亡指数显著增高，差异均有显著性意义(P＜0.01)；②非囊性扩张型与对照组比较，差异无显著性意义(P＞0.05)；③曲张静脉囊性扩张型和非囊性扩张型胶原含量均显著高于对照组(P＜0.05和P＜0.01)；④囊性扩张型内膜、中膜明显变薄(P＜0.01)；⑤逐步回归和相关分析提示静脉壁胶原蛋白含量和中膜SMC凋亡对静脉壁厚度作用较大(P=0.04143和P=0.006563)。胶原含量越高，管壁厚度越大(r=0.9777,P＜0.001)；中膜SMC凋亡指数越大，管壁厚度越薄(r=-0.5432,P=0.003)，而内膜ECs和SMC凋亡指数与管壁厚度无相关性(r=0.1619,P=0.420)；⑥电镜超微结构显示曲张静脉ECs和SMC呈典型凋亡形态学特征。结论　静脉胶原含量增加，细胞过度凋亡和细胞构成减少导致静脉血管重塑，可能是静脉曲张发病机理之一。

THE EFFECT OF CELLSAPOPTOSIS WITH VARICOSITY IN THE LOWER EXTREMITIES

Objective To explore the effect of apoptosis and venous remodeling in the varicosity. Methods By using TUNEL, Van Gieson collagen staining, venous wall image and transmission electron microscope, 83 patients with varicosity and 10 controls were studied. Results Apoptosis and apoptosis index of ECs and SMC in cystic dilatations were compared with those of non-cystic dilatations and controls with significant difference(P<0.01). The collagen content in patients with cystic dilatations and non-cystic dilatations were higher than that of controls (P<0.05, P<0.01). The venous wall of cystic dilatations become more thinner(P<0.01). The regression and correlation analysis showed that collagen contents and SMC apoptosis index had significant effect on venous wall (r=0.9777,P<0.001 and r=-0.5432, P=0.003) respectively. Electron microscopy confirmed apoptosis of ECs and SMC in varicosity. Conclusion Increased collagen content, increased cell apoptosis and reduced cell component lead to venous remodeling, and it may be one of the mechanism of varicosity.