Sudha M Lakshmi, Sundaram Sandhya, Purushothaman K Raman, Kumar P Sampath, Prathiba D
Department of Pathology, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra Universiy, Porur, Chennai-600 116, India.
Indian J Pathol Microbiol. 2009 Oct-Dec;52(4):486-9. doi: 10.4103/0377-4929.56130.
The incidence of ischemic heart disease (IHD) has markedly increased in India over the past few years. Considering the variations in racial, dietary and lifestyle patterns in our population, it is essential to study the biology of coronary atherosclerosis in our patients. Vulnerable plaques have a large number of foam cells, extracellular lipid, thin fibrous caps and clusters of inflammatory cells and are more prone to rupture. These plaques are nourished by the microvessels arising from the vasa vasorum of the blood vessels and by lumen-derived microvessels through the fibrous cap. This autopsy study was designed to analyse the coronary arterial tree in cases of sudden cardiac death, classify coronary atherosclerotic plaques and to assess the factors contributing to vulnerability of the plaques including inflammation, calcification and microvascular density.
Seven cases of sudden cardiac death were included in the study. The hearts were perfusion-fixed and the coronary arteries along with their main branches were dissected and studied. The location of the plaques, type of plaques, presence of inflammation and calcification were assessed. The cap thickness and microvessel density per 1000 um 2 were assessed. The statistical significance was estimated.
Extensive high-grade coronary atherosclerotic disease was seen in all sudden cardiac death cases. Majority of the plaques were vulnerable. High-grade inflammation was seen in most of the vulnerable and ruptured plaques. All the ruptured plaques were uncalcified indicating that calcification probably stabilizes the plaques and protects against rupture. Increased microvessel density was noted in ruptured plaques compared to vulnerable plaques. However, it was not statistically significant.
在过去几年中，印度缺血性心脏病（IHD）的发病率显著上升。鉴于我国人群在种族、饮食和生活方式上存在差异，研究我国患者冠状动脉粥样硬化的生物学特性至关重要。易损斑块含有大量泡沫细胞、细胞外脂质、薄纤维帽和炎症细胞簇，更容易破裂。这些斑块由血管滋养血管产生的微血管以及通过纤维帽的管腔衍生微血管提供营养。本尸检研究旨在分析心脏性猝死病例的冠状动脉树，对冠状动脉粥样硬化斑块进行分类，并评估导致斑块易损性的因素，包括炎症、钙化和微血管密度。
本研究纳入了7例心脏性猝死病例。对心脏进行灌注固定，解剖并研究冠状动脉及其主要分支。评估斑块的位置、斑块类型、炎症和钙化的存在情况。评估纤维帽厚度和每1000平方微米的微血管密度。评估统计学意义。
在所有心脏性猝死病例中均发现广泛的重度冠状动脉粥样硬化疾病。大多数斑块为易损斑块。在大多数易损和破裂斑块中可见重度炎症。所有破裂斑块均未钙化，表明钙化可能使斑块稳定并防止破裂。与易损斑块相比，破裂斑块中的微血管密度增加。然而，差异无统计学意义。
