主动脉夹层破裂与非破裂管壁的病理学对比观察

目的探讨炎性细胞和金属基质蛋白酶(MMPs)与主动脉夹层病变的关系。方法对本教研室1999年~2001年尸检14例主动脉夹层破裂致死(破裂组)和8例主动脉夹层因其它疾病死亡(未破裂组)的尸检案例资料,应用W e igert弹性纤维染色和免疫组化染色对两组主动脉夹层的动脉壁结构,CD68着色及MMP-9活性进行对比观察,并对免疫组化阳性染色进行图像分析。结果W e igert染色显示,两组管壁弹力纤维和胶原纤维均有较明显的分离、断裂或消失,但破裂组病变程度比未破裂组更重。免疫组化与图像分析结果显示,CD68阳性细胞的平均光密度值在破裂组为0.933±0.750,未破裂组为0.617±0.674;MMP-9活性的平均光密度值在破裂组为0.924±0.541,未破裂组为(0.651±0.988);两组间存在显著性差异(P<0.01)。结论炎性细胞浸润程度和MMP-9活性与主动脉夹层动脉管壁的病变程度及破裂紧密相关。

A comparative study between the aortic walls of dissecting aneurysm with rupture and without rupture

Objective To investigate the role of inflammatory infiltration and expression of matrix metalloproteinase-9(MMP-9) on the pathologic changes of aortic dissecting aneurysm(ADA).Methods Samples of aortic wall of dissecting aneurysm with rupture in 14 cases(rupture group) and without rupture in 8 cases(control group) were obtained from the autopsied files in our department from 1999～2001.The pathologic changes of collagen and elastin on the media of aortic wall,the immunoreactive cell to CD68 and expression of MMP-9 in aortic wall were observed by Weigert staining,immunohistochemical staining and image analysis.Results The collagen and elastin on the media of aortic wall in the cases of rupture group had more significant destruction in comparison with the cases of control group by the Weigert staining.The value of average optical density for positive CD68 cells and MMP9 were respectively 0.933±0.750 and 0.924±0.541 in rupture group and 0.617±0.674 and 0.651±0.988 in the control group(P<0.01).Conclusions The inflammatory infiltration and expression of MMP-9 on the aortic wall may be an important factor in the pathogenesis and the rupture of ADA.