Department of Neurology, Beijing Military General Hospital, Beijing, 100700, China.
Chin Med J (Engl). 2009 Dec 20;122(24):2985-8.
Small cerebrovascular lesions are one of the most important factors in cerebral amyloid angiopathy (CAA) and vascular dementia (VaD). We analyzed the difference of arteriolar pathology between CAA patients (CAAs) and vascular dementia patients without CAA (VaDs).
Ten deceased CAAs and twelve deceased VaDs were available for this study. Five deceased patients without known cerebrovascular diseases served as controls. These patients were all autopsy cases. All transversely cut arterioles in the gray matter and white matter with an external diameter equal to or larger than 30 microm and with a maximum of 300 microm were examined. The internal and external diameters of arterioles were measured.
The external diameter of gray matter arterioles in the CAAs was significantly greater than in controls. In gray matter arterioles, the diameter of the lumen in VaDs was markedly smaller than in the CAAs, whereas there was no significant difference between CAAs and controls. CAAs and VaDs may cause remarkable thickening of the arteriolar walls in either white matter or gray matter. The sclerotic index of arterioles in VaDs was significantly greater than in CAAs and controls.
Stenosis of arterioles occurred in both CAA and VaD, but the tendency was greater in VaD. Arterioles of CAA were also expanded in gray matter, which may be related to lobar hemorrhage. The loss and/or degeneration of vascular smooth muscle cells was predominant in CAA, while the over-proliferation of vascular smooth muscle cells was greater in VaD.
小血管病变是脑淀粉样血管病（CAA）和血管性痴呆（VaD）最重要的因素之一。我们分析了 CAA 患者（CAAs）和无 CAA 的血管性痴呆患者（VaDs）之间小动脉病理的差异。
本研究纳入了 10 例已故的 CAA 和 12 例已故的 VaD 患者，另外还有 5 例无已知脑血管疾病的已故患者作为对照组。这些患者均为尸检病例。所有横切的直径等于或大于 30μm、最大直径不超过 300μm 的灰质和白质的小动脉都进行了检查。测量了小动脉的内外径。
CAA 患者灰质小动脉的外径明显大于对照组。在灰质小动脉中，VaD 患者的管腔直径明显小于 CAA 患者，而 CAA 患者与对照组之间没有显著差异。CAA 和 VaD 可能导致白质或灰质中小动脉壁显著增厚。VaD 患者的小动脉硬化指数明显大于 CAA 和对照组。
CAA 和 VaD 都存在小动脉狭窄，但 VaD 的趋势更为明显。CAA 的小动脉在灰质中也扩张，这可能与脑叶出血有关。CAA 中小动脉平滑肌细胞的丢失和/或变性更为突出，而 VaD 中小动脉平滑肌细胞的过度增殖更为明显。
