高血压脑出血患者脑小动脉的超微结构  

The study on ultrastructure of arteriole in patients with hypertensive intracerebral hemorrhage

作　　者：王东春 李晓丽 王硕[2] 季楠[2] 孙异临[3] 

机构地区：[1]河北省唐山市工人医院,唐山063000 [2]北京市天坛医院神经外科 [3]北京市神经外科研究所电镜室

出　　处：《中国神经精神疾病杂志》2010年第3期133-136,共4页Chinese Journal of Nervous and Mental Diseases

摘　　要：目的用电子显微镜观察高血压脑出血患者出血责任动脉或血肿壁周围穿支动脉超微结构特点,探索高血压脑出血的微观机制。方法选择神经外科收治的12例CT证实并手术治疗的高血压脑出血患者,术中经皮质造瘘收集小动脉标本,在电子显微镜下观察其超微结构特点。结果12例标本中出血责任动脉4例,穿支动脉8例。电子显微镜下内皮细胞改变包括内皮细胞坏死、崩解、脱落;伴有内弹力膜变性、厚薄不均、断续不完整;以及中膜平滑肌细胞坏死、胞浆内肌丝凝聚成高电子致密物质。未见微动脉瘤结构。结论高血压患者脑小动脉壁的主要承力层的变化病理基础包括:内弹力层断裂、平滑肌层变性,弹性下降、钢性或脆性增加;在血流突变的情况下血管壁可发生钢性断裂或撕裂出血。Objective To examine ultrastructural features of the arteriole responsible for intracerebral hemorrhage or the perforating branches artery around hematoma in patients with hypertensive intracerebral hemorrhage and explore the mechanism of hypertensive intracerebral hemorrhage.Methods Twelve hypertensive patients with CT proved intracerebral hemorrhage underwent operation.The small artery specimens were obtained through cortex fistula and their ultrastructures were observed under the electron microscope.Results Twelve specimens including 4 cases of duty arteriolae and 8 cases of perforating branch arteriolae were collected,Different degrees of degeneration were observed in three layers of the arteriola in all 12 specimens.Changes in endothelial cells included endothelial cell necrosis,collapse,or fallen of from endomembrane,accompanied by degeneration of internal elastic membrane,such as uneven thickness,absence of intermittent and medial smooth muscle cell necrosis.Myofilaments in the cytoplasm were condensed to form a high electron-dense cytoplasm.No micro-aneurysm was observed.Conclusions The pathological changes of cerebral small artery walls load-bearing layer in hypertensive patients include internal elastic layer rupture,smooth muscle layer of degeneration,decreased elasticity and increased fragility.Small artery walls may rupture,resulting in bleeding under the condition of rapid dynamic changes of blood flow.

关 键 词：高血压脑出血 病理学 超微结构 

分 类 号：R544.1[医药卫生—心血管疾病] R743.3[医药卫生—内科学]