Li Xiaoying, Li Rui, Yu Wen, Shi Huaiyin, Wei Lixin
Department of Cardiology, Chinese PLA General Hospital, Beijing 100853, China.
Chin Med J (Engl). 2002 May;115(5):658-63.
To observe the characteristics of coronary microvascular lesions (CML) in the autopsied elderly cases with hypertensive left ventricular hypertrophy (LVH) and the difference of CML among the groups of essential hypertension (EHT), coronary heart disease (CHD) and diabetes (NIDDM) also with LVH.
A retrospective study was performed in 206 cases > or = 60 years old of EHT, CHD and NIDDM with LVH and 30 normal cases as control, out of 3195 consecutive autopsied cases from 1954 to 1996 in our hospital. Arterioles with diameters of 10 - 60 microm and capillaries in the muscular layer were shown by the methods of HE, Elastic fiber + VG staining and immunohistochemistry of CD31. Quantitative measurements on the arteriole density (AD), the ratio of arteriolar wall and cavity (RWC), capillary density (CD) and the area of endothelial cell (AEC) were performed with light microscope observation and image analysis by computer. According to the thickness of the left ventricle free wall, the severity of LVH was divided into four degrees from 0 to III. LVH of degree 0-III was observed in EHT group, while only LVH of degree I was found in CHD, EHT + CHD, and NIDDM groups. SAS system was used for statistical analysis.
AD and RWC increased while CD and AEC decreased significantly with the progression of LVH in EHT groups (P < 0.05 - 0.01). There was a similar but more severe change in the (HT + CHD) group (P < 0.01); the AD increased (P < 0.05) while all other measurements did not show obvious changes in the CHD group. The AD increased, CD and AEC decreased (all P < 0.05), but RWC did not change very much in the NIDDM group.
CML in the EHT group was characterized by an increased AD and RWC, decreased CD and AEC, among which the increased RWC was the typical change in EHT groups compared with the groups of CHD and NIDDM. Damaged CML may be one of the main factors for decreased coronary flow reserve and myocardial ischemia in cases of EHT with LVH.
观察老年高血压左心室肥厚（LVH）尸检病例冠状动脉微血管病变（CML）的特点，以及原发性高血压（EHT）、冠心病（CHD）和糖尿病（NIDDM）伴LVH组间CML的差异。
对我院1954年至1996年连续尸检的3195例病例中的206例年龄≥60岁的EHT、CHD和NIDDM伴LVH患者及30例正常对照进行回顾性研究。采用HE、弹性纤维+VG染色及CD31免疫组化方法显示直径为10 - 60微米的小动脉及肌层毛细血管。通过光学显微镜观察和计算机图像分析对小动脉密度（AD）、小动脉壁腔比（RWC）、毛细血管密度（CD）及内皮细胞面积（AEC）进行定量测量。根据左心室游离壁厚度，将LVH严重程度分为0至III度。EHT组观察到0 - III度LVH，而CHD、EHT + CHD和NIDDM组仅发现I度LVH。采用SAS系统进行统计分析。
EHT组中，随着LVH进展，AD和RWC升高，而CD和AEC显著降低（P < 0.05 - 0.01）。（HT + CHD）组有类似但更严重的变化（P < 0.01）；CHD组AD升高（P < 0.05），而其他测量指标无明显变化。NIDDM组AD升高，CD和AEC降低（均P < 0.05），但RWC变化不大。
EHT组CML的特点是AD和RWC升高，CD和AEC降低，其中RWC升高是EHT组与CHD和NIDDM组相比的典型变化。受损的CML可能是EHT伴LVH病例冠状动脉血流储备降低和心肌缺血的主要因素之一。
