Micheletti Robert G, Fishbein Gregory A, Currier Judith S, Singer Elyse J, Fishbein Michael C
Department of Medicine, Division of Infectious Diseases, University of California at Los Angeles, Los Angeles, CA 90035, USA.
Mod Pathol. 2008 Aug;21(8):1019-28. doi: 10.1038/modpathol.2008.89. Epub 2008 Jun 6.
Two well-recognized patterns of calcification occur in large- and medium-sized arteries, intimal calcification associated with atherosclerosis and medial calcification described by Mönckeberg. Calcification limited to the internal elastic lamina is a third pattern of calcification not previously reported in coronary arteries. Here we describe 19 cases of coronary artery internal elastic lamina calcification. We serially sectioned and examined the coronary arteries of 66 patients with advanced AIDS and 27 HIV- controls with other chronic illnesses. We observed calcification of the internal elastic lamina in 10 HIV+ patients and 9 controls. HIV- patients with internal elastic lamina calcification were significantly older than HIV- patients without it (P=0.008) and HIV+ patients with it (P=0.006). Occasionally, calcification encroached on adjacent intimal or medial tissue with mild fibrosis. There was frequent disruption of the internal elastic lamina but no evidence of inflammation. Calcification was the dominant histologic feature in all cases. Von Kossa, Alizarin red, and trichrome/elastic stains confirmed these findings. Patients with internal elastic lamina calcification often had extensive medical histories but did not suffer from chronic renal failure or other conditions known to cause calcium dysregulation. We describe coronary internal elastic lamina calcification in HIV+ patients and older HIV- adults. The clinical significance of this finding is unknown. It could lead to arterial stiffening and increased pulse pressure and could be mistaken for intimal calcification on coronary imaging. Internal elastic lamina calcification may result from premature aging due to HIV disease and chronic illness or from metabolic disorders in HIV+ patients.
在大中型动脉中出现两种公认的钙化模式，即与动脉粥样硬化相关的内膜钙化和由蒙克贝格描述的中膜钙化。局限于内弹性膜的钙化是冠状动脉中先前未报道的第三种钙化模式。在此，我们描述19例冠状动脉内弹性膜钙化病例。我们对66例晚期艾滋病患者和27例患有其他慢性疾病的HIV阴性对照者的冠状动脉进行了连续切片检查。我们在10例HIV阳性患者和9例对照者中观察到了内弹性膜钙化。有内弹性膜钙化的HIV阴性患者比无钙化的HIV阴性患者（P = 0.008）以及有钙化的HIV阳性患者（P = 0.006）年龄显著更大。偶尔，钙化会侵犯相邻的内膜或中膜组织并伴有轻度纤维化。内弹性膜常有破坏但无炎症迹象。钙化是所有病例中的主要组织学特征。冯·科萨染色、茜素红染色和三色/弹性染色证实了这些发现。有内弹性膜钙化的患者通常有广泛的病史，但未患慢性肾衰竭或其他已知会导致钙调节异常的疾病。我们描述了HIV阳性患者和老年HIV阴性成年人中的冠状动脉内弹性膜钙化。这一发现的临床意义尚不清楚。它可能导致动脉僵硬和脉压增加，并且在冠状动脉成像时可能被误诊为内膜钙化。内弹性膜钙化可能是由于HIV疾病和慢性疾病导致的早衰，或者是HIV阳性患者的代谢紊乱所致。
