冠状动脉旁路移植术所用桡动脉与乳内动脉的超微结构比较  

Comparative study on the ultrastructures of radial and internal mammary arteries used for coronary artery bypass grafting

作　　者：王红月[1] 孟颖[1] 罗新锦[2] 褚雁[1] 徐新林[1] 孙寒松[2] 阮英茆[1] 

机构地区：[1]中国医学科学院中国协和医科大学阜外心血管病医院病理科 [2]中国医学科学院中国协和医科大学成人心脏外科中心

出　　处：《中华病理学杂志》2005年第8期528-532,共5页Chinese Journal of Pathology

摘　　要：目的桡动脉与乳内动脉的生物学特性及冠状动脉旁路移植术后的远期通畅率不同,本研究拟了解桡动脉与乳内动脉的超微结构差异及其对移植术后血管重构的可能影响。方法在冠状动脉旁路移植术中采集桡动脉远端34例及乳内动脉远端11例。用电镜观察、比较两种动脉的内皮细胞及其脱落比例、内膜平滑肌细胞表型、基质分泌量、内中膜脂质和中层亚显微钙化的有无、中层平滑肌细胞的超微形态和排列。结果桡动脉内膜较厚,内膜平滑肌细胞较多而密集。它在分泌态内皮细胞(47.1%,16/34)、合成型平滑肌细胞比例(14.4%)、内膜脂质(内膜44.1%,15/34;中膜58.8%,20/34)和基质分泌量增加(14.7%,5/34)方面高于乳内动脉(分别为27.2%,3/11;0.9%;内膜18.2%,2/11及中膜54.5%,6/11;9.1%,1/11)。动脉中膜可出现较多基质小泡及其钙化,而光镜水平未发现钙化,姑且称之为亚显微钙化。桡动脉的中层脂质和亚显微钙化与乳内动脉持平,内皮细胞的肿胀脱落却少于乳内动脉。两者的中层平滑肌细胞结构和排列未见显著差异。结论冠心病患者桡动脉内皮细胞功能状态和内膜平滑肌细胞潜在的增殖能力高于乳内动脉,它可能参与移植术后重构,并与其远期通畅率较低有关。桡动脉获取中内皮保护较乳内动脉好,有利于通畅率的提高。Objective The radial artery differs from internal mammary artery in its vascular biology and long-term patency after coronary artery bypass grafting （CABG）. This study was designed to investigate their ultrastructural differences that may have implications in arterial remodeling and graft failure. Methods Thirty-four radial artery and 11 internal mammary artery samples were obtained from patients underwent CABG, and subjected to routine electron microscopic examination. A semi-quantitative method was used to evaluate secretary endothelial cells, endothelial denudation, synthetic smooth muscle cells （SMCs） , matrix accumulation, lipid deposition and medial submicroscopic calcification. Results Compared with internal mammary arteries, the radial arteries had more secretory endothelial cells （47. 1% , 16/34 vs 27.2% , 3/11 ） and synthetic type SMCs in a background （ 14. 4% vs 0. 9% ） that had more intimal lipid deposition and matrix accumulation （ 14. 7%, 5/34 vs 9. 1%, 1/11 ）. Matrix vesicles and calcifications were frequently present in the media of both types of arteries. The calcifications, however, could not be visualized by routine histological stains, and therefore, named as submicroscopic calcification in this study. Fewer endothelial denudations were observed in the radial arteries, but no differences in medial lipid deposition and submicroscopic calcification were observed between these two types of arteries. The ultrastrnctural features and the arrangement of medial SMCs in radial arteries were similar to those of internal mammary arteries.Conclusions Radial arteries have a higher SMC proliferative potential and more actively secretory status of endothelial cells, which may enhance the remodeling process and correlate with a decreased long-term patency. Better preservation of endothelial cells in radial arteries could be attributed to the “no touch” technique utilized in surgical harvesting. The significance of submicroscopic medial calcification during graft remodeling requires fu

关 键 词：冠状动脉分流术 桡动脉 移植 自体 肌 平滑 血管 冠状动脉旁路移植术 乳内动脉 超微结构 平滑肌细胞表型 动脉内皮细胞 内膜平滑肌细胞 

分 类 号：R654.2[医药卫生—外科学] R543.16[医药卫生—临床医学]