Aneurysmal and occlusive atherosclerosis of the human abdominal aorta
Aneurysmal and occlusive atherosclerosis of the human abdominal aorta
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DOI：
10.1067/mva.2001.109744
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发表时间：
2001-01-01
影响因子：
4.3
通讯作者：
Glagov, S
中科院分区：
文献类型：
--
作者：
Xu, CP;Zarins, CK;Glagov, S
目的：本研究的目的是评估腹主动脉粥样硬化斑块沉积和主动脉壁反应与肾下主动脉粥样硬化和闭塞性疾病发展的关系。方法：在67例压力灌注固定的男性尸体腹主动脉中，（年龄41-98岁，平均66岁），并与腹腔上段进行比较。组织学切片的定量计算机辅助形态测量包括斑块面积、管腔面积、管腔直径、中膜厚度、内侧弹性膜数量以及最能代表各段动脉大小的内弹性膜所包围的面积的测量。腹腔上段与腹中段的比例（通常大于1.3）用于定义三组：组I（正常）：比率大于或等于1.30（n = 31）;组II（正常）：比率大于或等于1.30（n = 31）;组III（正常）：比率大于或等于1.30（n = 31）。（中间型）：比值大于或等于1.20但小于1.30（n = 20）;和组III：比值小于1.20（n = 16），其代表扩张的中腹部腹动脉瘤。各组间年龄无显著差异。结果：I组内膜斑块最少，动脉粥样硬化的肉眼证据很少。与I组相比，II组内膜斑块增加（P <0.01），动脉粥样硬化的大体证据最大限度地位于远端主动脉;斑块下方的主动脉没有扩大或变薄。第三组的内膜斑块多于第一组（P < .01）和第二组（P < .01），并且与第一组（P < .05）和第二组（P < .01）相比，与局部主动脉扩大和中膜变薄有关。III组内膜斑块的增加与管腔直径的增加相关（r = 0.61，P <0.05），但在I组和II组中这种关系不显著。组III的主动脉中膜的内侧弹性膜的数量减少，厚度减少，并且比组I和组II的腹主动脉中膜更容易受到增加的壁应力的影响。结论：这些结果表明，在人类腹主动脉中可能存在不同的局部反应。与局部扩张、中膜变薄和内侧弹性膜丧失相关的斑块沉积可能使该段主动脉易于随后形成动脉瘤。斑块沉积而无中膜变薄、无弹性膜丧失、无动脉壁扩张，在斑块持续积聚的情况下，可能使主动脉易于发生管腔狭窄。
Purpose: The purpose of this study was to assess atherosclerotic plaque deposition and aortic wall responses in the abdominal aorta in relation to the development of aneurysmal and occlusive disease in the infrarenal aorta.Methods: Morphologic differences at five standardized locations in the infrarenal aorta in 67 pressure perfusion-fixed male cadaver aortas (aged, 41-98 years; mean, 66 years) were studied and compared with the supraceliac segment. Quantitative computer-assisted morphometry of histologic sections included measurement of plaque area, lumen area, lumen diameter, media thickness, number of medial elastic lamellae, and the area encompassed by the internal elastic lamina that best represents the artery size of each segment. The ratio of the supraceliac segment to the midabdominal segment (normally greater than 1.3) was used to define three groups: Group I (normal): ratio greater than or equal to 1.30 (n = 31); Group II (intermediate): ratio greater than or equal to 1.20 but less than 1.30 (n = 20); and Group III: ratio less than 1.20 (n = 16), which represented dilated midabdominal aortas. There was no significant difference in age among the groups.Results: Group I had minimal intimal plaque and little gross evidence of atherosclerosis. Group II had increased intimal plaque compared with Group I (P < .01) and gross evidence of atherosclerosis, which was maximally localized in the distal aorta; there was no aortic enlargement or thinning of the media underneath the plaque. Group III had more intimal plaque than Group I (P < .01) and Group II (P < .01) and was associated with localized aortic enlargement and media thinning compared with Group I (P < .05) and Group II (P < .01). Increasing intimal plaque in Group III correlated with an increase in lumen diameter (r = 0.61, P < .05), but this relationship was not significant in Group I and Group II. The aortic media in Group III had a reduced number of medial elastic lamellae, was reduced in thick ness, and was more exposed to increased wall stress than the aortas in Groups I and II.Conclusion: These results suggest that there may be different local responses to atherosclerosis in the abdominal aorta in human beings. Plaque deposition associated with localized dilation, thinning of the media, and loss of medial elastic lamellae may predispose that segment of aorta to subsequent aneurysm formation. Plaque deposits without media thinning, without loss of elastic lamellae, and without artery wall dilation may predispose the aorta, in the event of continuing plaque accumulation, to the development of lumen stenosis.