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

・临床研究・

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

张微微1

,黄勇华1

,魏东宁2

,周小英

1

(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)

摘要:目的　对脑淀粉样血管病(C AA )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C AA 、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β2A 4为阴性,Ⅰ、Ⅲ、Ⅴ型胶原呈阳性反应,Ⅳ型为弱阳性。病例组C AA 患者中层细胞外间质β2A 4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　C AA 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,且肌动蛋白减少。关键词:脑淀粉样血管病;免疫组织化学;病理学;细胞外基质

中图分类号:R743 文献标识码:A 文章编号:100920126(2003)0520312203

Comparative pathological studies on cerebral amyloid angiopathy and

hyalinosis of microvessels in the human brain

ZH ANG Wei 2wei ,H UANG Y ong 2hua ,WEI Dong 2ning ,et al

(Department o f Neurology ,G eneral Hospital o f Beijing Military Area ,Beijing 100700,China )

Abstract :Objective T o investigate the amyloid deposit com ponent of extracelluar matrix (EC M )of cerebral

amyloid angiopathy (C AA )and com position of hyaline material in cerebral blood vessels respectively.Methods Immunohistochemistry was used to observe sam ples obtained from 10autopsy cases with marked amyloid angi 2opathy ,8cases presenting hyaline changes of cerebral vessels and a control group of 8postm ortem cases with 2out encephalopathy.A number of primary antisera were used to visualise different com ponents of EC M ,sm ooth muscle cells and endothelial cells under the microscope.R esults The controls showed negative result with β2A 4and slightly positive with collagen Ⅳ.The deposit of EC M material of C AA indicating laminin and collagen

Ⅳoccurred particularly in the media.The immunostained markers of adventitia did not reveal much changes as com pared with the controls.The com position of the hyaline material included collagen types Ⅰ,Ⅲ,Ⅴand Ⅳas well as basal lamina com ponents collagen Ⅳand laminin ,but the actin decreased.Conclusion Severe amyloid angiopathy with deposition of collagen type Ⅳand laminin and loss of the fibrous collagens in media may make the arteries m ore susceptible to rupture and hem orrhage.Degeneration of the media ass ociated with deposition of collagen types ⅠⅢⅤⅣ,as well as other com ponents of EC M ,and a severe reduction of actin in the media jeopardise the regulatory functions of the afflicted vessels.

K ey w ords :cerebral amyloid angiopathy ;immunohistochemistry ;pathology ;extracellular matrix

收稿日期:2003203206

基金项目:国家自然科学基金(39770753)

作者简介:张微微,女,1952年6月生,上海市人,主任医师,教授,博

士,博士生导师,从事神经内科专业。

脑小动脉病主要包括脑淀粉样血管病(C AA )和脑小动脉玻璃样病变。国际上对于C AA 的研究热点以沉淀物的性质为主,有关其引发出血的病理机

制报道较少[1,2]

。对于恢复的小动脉病,其流行病学和影像学研究较多,而与C AA 对比病理变化的特点

报道较少[3～5]

。我们的研究利用免疫组织化学对此两种脑小动脉病患者的脑组织小血管中层和外层细胞外间质成分进行深入研究,揭示脑小动脉淀粉样变和玻璃样变不同的病理机制,以期为临床提供理论依据。