老年人脑微出血：病理分析。
Cerebral microbleeds in the elderly: a pathological analysis.
机构信息
Department of Neurology, University of California, Irvine, CA 92868, USA.
出版信息
Stroke. 2010 Dec;41(12):2782-5. doi: 10.1161/STROKEAHA.110.593657. Epub 2010 Oct 28.
BACKGROUND AND PURPOSE
Cerebral microbleeds in the elderly are routinely identified by brain MRI. The purpose of this study was to better characterize the pathological basis of microbleeds.
METHODS
We studied postmortem brain specimens of 33 individuals with no clinical history of stroke and with an age range of 71 to 105 years. Cerebral microbleeds were identified by presence of hemosiderin (iron), identified by routine histochemistry and Prussian blue stain. Cellular localization of iron (in macrophages and pericytes) was studied by immunohistochemistry for smooth muscle actin, CD68, and, in selected cases, electron microscopy. Presence of β-amyloid was analyzed using immunohistochemistry for epitope 6E10.
RESULTS
Cerebral microbleeds were present in 22 cases and occurred at capillary, small artery, and arteriolar levels. Presence of microbleeds occurred independent of amyloid deposition at site of microbleeds. Although most subjects had hypertension, microbleeds were present with and without hypertension. Putamen was the site of microbleeds in all but 1 case; 1 microbleed was in subcortical white matter of occipital lobe. Most capillary microbleeds involved macrophages, but the 2 microbleeds studied by electron microscopy demonstrated pericyte involvement.
CONCLUSIONS
These findings indicate that cerebral microbleeds are common in elderly brain and can occur at the capillary level.
背景与目的
老年人的脑微出血可通过脑部 MRI 常规识别。本研究旨在更好地描述微出血的病理基础。
方法
我们研究了 33 例无卒中临床病史且年龄在 71 至 105 岁之间的尸检脑标本。通过常规组织化学和普鲁士蓝染色鉴定含铁血黄素（铁）来识别脑微出血。通过免疫组织化学检测平滑肌肌动蛋白、CD68 来研究铁的细胞定位（在巨噬细胞和周细胞中），并在特定情况下使用电子显微镜。使用针对表位 6E10 的免疫组织化学分析 β-淀粉样蛋白的存在。
结果
22 例存在脑微出血，发生在毛细血管、小动脉和小动脉水平。微出血的存在与微出血部位的淀粉样蛋白沉积无关。尽管大多数患者有高血压，但微出血的存在与高血压无关。除 1 例外，壳核均为微出血部位；1 例微出血位于枕叶皮质下白质。大多数毛细血管微出血涉及巨噬细胞，但通过电子显微镜研究的 2 个微出血显示周细胞受累。
结论
这些发现表明，脑微出血在老年人的脑部很常见，可发生在毛细血管水平。
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