Hellings W E, Pasterkamp G, Verhoeven B A N, de Kleijn D P V, de Vries J P P M, Seldenrijk C A, van den Broek T, Moll F L
Afd. Vaatchirurgie, Universitair Medisch Centrum Utrecht, Heidelberglaan 100, 3584 CX Utrecht.
Ned Tijdschr Geneeskd. 2008 Nov 29;152(48):2624-31.
To determine whether men and women differ in the histological characteristics of plaque material removed at carotid endarterectomy.
Observational and descriptive.
Carotid endarterectomy plaque specimens obtained from 45 degrees consecutive patients (135 women, 315 men) were assessed for the presence of macrophages, smooth muscle cells, collagen, calcifications, and luminal thrombus by means ofimmunohistochemical staining. The plaques were categorised in 3 phenotypes according to the overall presentation of histological characteristics and the lipid level. Protein was isolated from the plaques to determine the interleukin-6 (IL-6) and IL-8 concentrations and the activity of matrix metalloproteinase-8 (MMP-8) and MMP-9.
Atheromatous plaques (> 40% fat) were less frequently observed in women than in men (22 versus 40%; p < 0.001). In addition, more women than men had a low macrophage staining (18 versus 11%; p = 0.05) and strong smooth muscle cell staining (38 versus 24%; p = 0.001). Compared with men, women had a lower plaque concentration of IL-8 and lower MMP-8 activity. The observed differences were most pronounced in the asymptomatic group. An atheromatous plaque occurred in 9% of asymptomatic women compared to 39% ofasymptomatic men (p = 0.02). Moreover, a large proportion of plaques obtained from asymptomatic women showed high smooth muscle cell content (53 versus 30%; p = 0.03) and high collagen content (55 versus 24%; p = 0.003). All relations between gender and plaque characteristics, except for MMP-8, remained the same in a multivariate analysis that was adjusted for clinical presentation and other cardiovascular risk factors.
Women with a carotid stenosis had more stable plaques than men, independent of clinical presentation and cardiovascular risk profile. Asymptomatic women demonstrated the highest prevalence of stable plaques. These findings may explain why women benefit less from carotid endarterectomy than men.
确定在颈动脉内膜切除术时所切除斑块组织的组织学特征在男性和女性中是否存在差异。
观察性和描述性研究。
对连续450例患者（135例女性，315例男性）的颈动脉内膜切除术斑块标本进行评估，通过免疫组织化学染色检测巨噬细胞、平滑肌细胞、胶原蛋白、钙化和管腔内血栓的存在情况。根据组织学特征的总体表现和脂质水平，将斑块分为3种表型。从斑块中提取蛋白质，以测定白细胞介素-6（IL-6）和IL-8浓度以及基质金属蛋白酶-8（MMP-8）和MMP-9的活性。
女性中动脉粥样硬化斑块（脂肪含量>40%）的发生率低于男性（22%对40%；p<0.001）。此外，巨噬细胞染色低的女性多于男性（18%对11%；p=0.05），平滑肌细胞染色强的女性多于男性（38%对24%；p=0.001）。与男性相比，女性的斑块IL-8浓度较低，MMP-8活性较低。观察到的差异在无症状组中最为明显。9%的无症状女性出现动脉粥样硬化斑块，而无症状男性为39%（p=0.02）。此外，从无症状女性获得的大部分斑块显示平滑肌细胞含量高（53%对30%；p=0.03）和胶原蛋白含量高（55%对24%；p=0.003）。在针对临床表现和其他心血管危险因素进行调整的多变量分析中，除MMP-8外，性别与斑块特征之间的所有关系均保持不变。
患有颈动脉狭窄的女性比男性具有更稳定的斑块，与临床表现和心血管风险状况无关。无症状女性中稳定斑块的患病率最高。这些发现可能解释了为什么女性从颈动脉内膜切除术中获益比男性少。
