摘要
目的研究老年原发性高血压左心室肥厚（LVH）患者心、肾微动脉改变的病理特点，以发现两个靶器官微动脉结构变化的异同和相互联系。方法从解放军总医院1954-2004年连续尸检的病例中，选取年龄≥60岁经临床和尸检证实为原发性高血压LVH患者25例和对照组8例的心、肾标本为研究对象，其中原发性高血压组再按LVH程度（Ⅰ～Ⅲ级）分为三组，予HE、Masson染色后，用光镜配合电脑图像分析，定量检测心、肾微动脉几何形态学参数，并用半定量的方法评估微动脉的损伤指数和血浆蛋白浸润指数。结果高血压组心、肾微动脉血管几何形态学参数随LVH程度的增加呈现出有规律的变化趋势，表现为血管内径（ID）、管腔横截面积（LCSA）减小，而血管壁厚度（WT）、血管壁横截面积（WCSA）、壁腔横截面积比值（WCSA／LCSA）和壁厚内径比值（WT／ID）增大；不同外径（OD）范围的心肌、肾脏微动脉WCSA／LCSA和WT／ID比较均发现，随OD的增加，血管的WCSA／LCSA和WT／ID比值减小；相同OD范围的心、肾微动脉各项血管几何形态学参数比较有明显差异（P〈0．05）；高血压组心、肾微动脉血浆蛋白浸润指数、血管损伤指数高于对照组（P〈0．01）；各组肾脏微动脉血管损伤指数、血浆蛋白浸润指数均高于心肌微动脉（P〈0．01）。结论原发性高血压患者心、肾微动脉均出现向心性重构，在血管OD范围为10～50μm的微动脉表现最明显，OD〈50μm的微动脉最易出现闭塞；心、肾微动脉血管重构随高血压LVH程度的增加而加重；高血压肾脏微动脉损伤比心肌微动脉重。微动脉病变是高血压靶器官损害的重要病理学基础。
Objective To determine the cardiac and renal arteriolar pathological changes in autopsied elderly hypertensive patients with left ventricular hypertrophy （LVH）. Methods Autopsy samples from 25 essential hypertension （EH） patients with LVH aged over 60 years and age-matched 8 controls were analyzed. LVH was further divided into three degrees from Ⅰ to Ⅲ according to left ventricular free wall thickness in EH patients. Quantitative measurements of arteriolar morphometric parameters in heart and kidney were performed under light microscope with computer image analysis post HE and Masson staining. The lesion index and plasma albumen infiltration of arteriole were evaluated by the semiquantitative method. Results The inner diameter （ID） and luminal cross-sectional area （LCSA） were significantly decreased while wall thickness （WT）, wall cross-sectional area （WCSA）, ratio of WCSA to LCSA （WCSA/LCSA） and ratio of WT to ID （WT/ID） were significantly increased in EH patients in proportion to LVH degree. Both cardiac and renal arterioles WCSA/LCSA and WT/ID were significantly decreased with increasing outer diameters （OD）. Under the same OD rang, the pathological changes were more significant in the renal arterioles compared to those in the cardiac arterioles （P 〈 0. 05 ）. The arteriolar lesion index and the plasma albumen infiltration index of cardiac and renal arterioles in EH group were significantly higher than those in the control group （P 〈0. 01 ） and the arteriolar lesion index and the plasma albumen infiltration of arteriole in the renal tissue were significantly higher than those in the cardiac tissue （ P 〈 0. 01 ）.Conclusion Concentric remodeling occurs in the cardiac and renal arterioles of EH patients in proportion to LVH degree and renal arterioles lesions were significantly severer than that of cardiac arterioles in EH patients with LVH.
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2008年第10期872-877,共6页
Chinese Journal of Cardiology
关键词
高血压
冠状动脉
肾动脉
心室复建
老年人
Hypertension
Coronary arterioles
Renal arterioles
Vascular remodeling
Aged
