McGill H C, McMahan C A, Herderick E E, Tracy R E, Malcom G T, Zieske A W, Strong J P
University of Texas Health Science Center at San Antonio, the Southwest Foundation for Biomedical Research, San Antonio, TX 78245-0549, USA.
Arterioscler Thromb Vasc Biol. 2000 Mar;20(3):836-45. doi: 10.1161/01.atv.20.3.836.
We examined topographic distributions of atherosclerosis and their relation to risk factors for adult coronary heart disease in right coronary arteries and abdominal aortas of more than 2000 autopsied persons 15 through 34 years of age. We digitized images of Sudan IV-stained fatty streaks and of manually outlined raised lesions and computed the percent surface area involved by each lesion in each of 6 regions of each artery. In abdominal aortas of 15- to 24-year-old persons, fatty streaks involve an elongated oval area on the dorsolateral intimal surface and another oval area in the middle third of the ventral surface. Raised lesions in 25- to 34-year-old persons involve an oval area in the distal third of the dorsolateral intimal surface. In other areas of the abdominal aortas of older persons, fatty streaks occur but raised lesions are rare. In the right coronary arteries of 15- to 24-year-old persons, fatty streaks are most frequent on the myocardial aspect of the first 2 cm. Raised lesions follow a similar pattern in 25- to 34-year-old persons. High non-HDL cholesterol and low HDL cholesterol concentrations are associated with more extensive fatty streaks and raised lesions in all regions of both arteries. Smoking is associated with more extensive fatty streaks and raised lesions of the abdominal aorta, particularly in the dorsolateral region of the distal third of the abdominal aorta. Hypertension is not associated with fatty streaks in whites or blacks but is associated with more extensive raised lesions in blacks. Risk factor effects on arterial regions that are vulnerable to lesions are approximately 25% greater than risk factor effects assessed over entire arterial segments. These risk factor effects on vulnerable sites emphasize the need for risk factor control during adolescence and young adulthood to prevent or delay the progression of atherosclerosis.
我们研究了2000多名15至34岁经尸检者右冠状动脉和腹主动脉中动脉粥样硬化的地形分布及其与成人冠心病危险因素的关系。我们将苏丹IV染色的脂肪条纹和手动勾勒出的隆起病变的图像数字化，并计算每条动脉6个区域中每个病变所累及的表面积百分比。在15至24岁人群的腹主动脉中，脂肪条纹累及背外侧内膜表面的一个细长椭圆形区域和腹侧表面中三分之一处的另一个椭圆形区域。25至34岁人群的隆起病变累及背外侧内膜表面远端三分之一处的一个椭圆形区域。在老年人腹主动脉的其他区域，脂肪条纹会出现，但隆起病变很少见。在15至24岁人群的右冠状动脉中，脂肪条纹在前2厘米的心肌侧最为常见。25至34岁人群的隆起病变也遵循类似模式。高非高密度脂蛋白胆固醇和低高密度脂蛋白胆固醇浓度与两条动脉所有区域更广泛的脂肪条纹和隆起病变相关。吸烟与腹主动脉更广泛的脂肪条纹和隆起病变相关，尤其是在腹主动脉远端三分之一的背外侧区域。高血压在白人或黑人中与脂肪条纹无关，但在黑人中与更广泛的隆起病变相关。危险因素对易患病变的动脉区域的影响比对整个动脉段评估的危险因素影响大约大25%。这些危险因素对易损部位的影响强调了在青少年和青年期控制危险因素以预防或延缓动脉粥样硬化进展的必要性。
