Moreno P R, Murcia A M, Palacios I F, Leon M N, Bernardi V H, Fuster V, Fallon J T
Gill Heart Institute, University of Kentucky, Lexington, KY, USA.
Circulation. 2000 Oct 31;102(18):2180-4. doi: 10.1161/01.cir.102.18.2180.
Lipid-rich, inflamed atherosclerotic lesions are associated with plaque rupture and thrombosis, which are the most important causes of death in patients with diabetes mellitus. This study was designed to quantify lipid composition and macrophage infiltration in the coronary lesions of patients with diabetes mellitus.
A total of 47 coronary atherectomy specimens from patients with diabetes mellitus were examined and compared with 48 atherectomy specimens from patients without diabetes. Plaque composition was characterized by trichrome staining. Macrophage infiltration was characterized by immunostaining. Clinical and demographic data were similar in both groups. The percentage of total area occupied by lipid-rich atheroma was larger in specimens from patients with diabetes (7+/-2%) than in specimens from patients without diabetes (2+/-1%; P:=0.01), and the percentage of total area occupied by macrophages was larger in specimens from patients with diabetes (22+/-3%) than in specimens from patients without diabetes (12+/-1%; P:=0.003). The incidence of thrombus was also higher in specimens from patients with diabetes than in specimens from patients without diabetes (62% versus 40%; P:=0.04). Plaque composition, macrophage infiltration, and thrombus were similar in lesions from diabetic patients treated with insulin compared with lesions from patients treated with sulfonylureas or diet.
Coronary tissue from patients with diabetes exhibits a larger content of lipid-rich atheroma, macrophage infiltration, and subsequent thrombosis than tissue from patients without diabetes. These differences suggest an increased vulnerability for coronary thrombosis in patients with diabetes mellitus.
富含脂质、炎症性动脉粥样硬化病变与斑块破裂和血栓形成相关，而这是糖尿病患者最重要的死亡原因。本研究旨在量化糖尿病患者冠状动脉病变中的脂质成分和巨噬细胞浸润情况。
共检查了47例糖尿病患者的冠状动脉旋切标本，并与48例非糖尿病患者的旋切标本进行比较。用三色染色法对斑块成分进行表征，用免疫染色法对巨噬细胞浸润进行表征。两组的临床和人口统计学数据相似。糖尿病患者标本中富含脂质的动脉粥样硬化所占总面积的百分比（7±2%）高于非糖尿病患者标本（2±1%；P = 0.01），糖尿病患者标本中巨噬细胞所占总面积的百分比（22±3%）高于非糖尿病患者标本（12±1%；P = 0.003）。糖尿病患者标本中的血栓发生率也高于非糖尿病患者标本（62%对40%；P = 0.04）。与接受磺脲类药物治疗或饮食治疗的患者的病变相比，接受胰岛素治疗的糖尿病患者的病变在斑块成分、巨噬细胞浸润和血栓方面相似。
与非糖尿病患者的组织相比，糖尿病患者的冠状动脉组织表现出富含脂质的动脉粥样硬化、巨噬细胞浸润以及随后的血栓形成的含量更高。这些差异表明糖尿病患者发生冠状动脉血栓形成的易感性增加。
