Wei L, Shi H, Guo A
Department of Pathology, General Hospital of PIA, Beijing 100853.
Zhonghua Bing Li Xue Za Zhi. 1998 Jun;27(3):168-70.
To compare the morphological difference of coronary atherosclerotic plaques in patients with stable angina(SA), unstable angina (UA) and acute myocardial infarction (AMI).
101 autopsy cases of patients with SA, UA and/or AMI were studied using routine histological and immunohistochemical staining.
Coronary atherosclerotic plaques in SA patients were mainly the fibrous plaques with no or just very small necrotic cores; rich in smooth muscle cells and collagen fibers, less foamy cells (stable plaque), low incidence of plaque rupture (14% only) and no thrombosis found. The atherosclerotic plaques in UA and AMI patients were mainly the atheroma (unstable plaque) with large necrotic core (> 40%), thin fibrous cap, less smooth muscle cells and abundant foamy cells. The incidences of plaque rupture were 76% and 82%, thrombosis 81% and 91% respectively in 58 cases of UA and 22 cases of AMI, and the incidence of UA is statistically significant in comparing with that of the SA group (P < 0.001).
In SA group, stable plaque was the main finding, plaque rupture and thrombosis rare. While in UA and AMI patients, unstable plaques predominant with a high incidence of plaque rupture and thrombosis which were the leading cause of acute coronary events.
比较稳定型心绞痛（SA）、不稳定型心绞痛（UA）和急性心肌梗死（AMI）患者冠状动脉粥样硬化斑块的形态学差异。
对101例SA、UA和/或AMI患者的尸检病例进行常规组织学和免疫组织化学染色研究。
SA患者的冠状动脉粥样硬化斑块主要为纤维斑块，无或仅有非常小的坏死核心；平滑肌细胞和胶原纤维丰富，泡沫细胞较少（稳定斑块），斑块破裂发生率低（仅14%），未发现血栓形成。UA和AMI患者的动脉粥样硬化斑块主要为粥样瘤（不稳定斑块），坏死核心大（>40%），纤维帽薄，平滑肌细胞少，泡沫细胞丰富。58例UA和22例AMI患者的斑块破裂发生率分别为７６％和８２％，血栓形成发生率分别为８１％和９１％，UA的发生率与SA组相比有统计学意义（P<0.001）。
SA组以稳定斑块为主，斑块破裂和血栓形成少见。而在UA和AMI患者中，不稳定斑块占主导，斑块破裂和血栓形成发生率高，是急性冠状动脉事件发生的主要原因。
