脑淀粉样血管病和脑小动脉玻璃样变性的病理学对比研究  

Comparative pathological studies on cerebral amyloid angiopathy and hyalinosis of microvessels in the human brain

作　　者：张微微[1] 黄勇华[1] 魏东宁[2] 周小英[1] 

机构地区：[1]北京军区总医院神经内科,北京100700 [2]解放军第三○九医院神经内科,北京100091

出　　处：《中华老年心脑血管病杂志》2003年第5期312-314,共3页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：国家自然科学基金 (3 9770 75 3 )

摘　　要：目的　对脑淀粉样血管病 (CAA)和脑小动脉玻璃样变的血管进行形态学观察 ,以期了解不同的病理机制。方法　利用ABC法对 10例CAA、8例脑血管玻璃样病变和 8例非脑病患者尸检脑标本的脑小动脉壁血管间质以及平滑肌细胞、内皮细胞进行病理形态学观察。结果　对照组脑小动脉 β A4 为阴性 ,Ⅰ、Ⅲ、Ⅴ型胶原呈阳性反应 ,Ⅳ型为弱阳性。病例组CAA患者中层细胞外间质 β A4 为阳性 ,Ⅳ型胶原和层蛋白纤维型胶原明显阳性 ,外层改变轻微。结论　CAA细胞外间质淀粉样物质异常沉积 ,层蛋白和Ⅳ型胶原堆积及纤维型胶原缺失 ;脑小动脉玻璃样变则是各型胶原层蛋白异常堆积于小动脉中层 。Objective To investigate the amyloid deposit component of extracelluar matrix(ECM)of cerebral amyloid angiopathy(CAA) and composition of hyaline material in cerebral blood vessels respectively.Methods Immunohistochemistry was used to observe samples obtained from 10 autopsy cases with marked amyloid angiopathy, 8 cases presenting hyaline changes of cerebral vessels and a control group of 8 postmortem cases without encephalopathy.A number of primary antisera were used to visualise different components of ECM,smooth muscle cells and endothelial cells under the microscope. Results The controls showed negative result with β-A 4 and slightly positive with collagen Ⅳ.The deposit of ECM material of CAA indicating laminin and collagen Ⅳ occurred particularly in the media.The immunostained markers of adventitia did not reveal much changes as compared with the controls.The composition of the hyaline material included collagen types Ⅰ,Ⅲ,Ⅴ and Ⅳ as well as basal lamina components collagen Ⅳ and laminin,but the actin decreased.Conclusion Severe amyloid angiopathy with deposition of collagen type Ⅳ and laminin and loss of the fibrous collagens in media may make the arteries more susceptible to rupture and hemorrhage. Degeneration of the media associated with deposition of collagen types Ⅰ Ⅲ Ⅴ Ⅳ, as well as other components of ECM, and a severe reduction of actin in the media jeopardise the regulatory functions of the afflicted vessels.

关 键 词：脑淀粉样血管病 免疫组织化学 病理学 细胞外基质 

分 类 号：R743.3[医药卫生—神经病学与精神病学]