Han Kum Hyun, Hennigar Randolph A, O'Neill W Charles
Renal Division, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA Department of Internal Medicine, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, Korea.
Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA.
Vasc Med. 2015 Dec;20(6):527-33. doi: 10.1177/1358863X15597076. Epub 2015 Aug 31.
The presence of bone tissue in calcified arteries may provide insights into the pathophysiology and potential reversibility of calcification, but the prevalence, distribution, and determinants of bone and osteoclasts in calcified arteries are unknown. Specimens of 386 arteries from lower limb amputations in 108 patients were examined retrospectively. Calcification was present in 282 arteries from 89 patients, which was medial in 64%, intimal in 9%, and both in 27%. Bone was present in 6% of arteries, essentially all of which were heavily calcified. Multiple sampling revealed that the true prevalence of bone in heavily calcified arteries was 25%. Bone was more common in medial rather than intimal calcifications (10% vs 3%, p=0.03) but did not vary with artery location (above vs below the knee). Heavily calcified arteries with bone were more likely to come from patients who were older (p=0.04), had diabetes (p=0.06), or were receiving warfarin (p=0.06), but there was no association with gender or renal failure. Bone was almost always adjacent to calcifications, along the periphery, but never within. Staining for the bone-specific proteins osteocalcin and osterix was noted in 20% and 45% of heavily calcified arteries without visible bone. Osteoclasts were present in 4.9% of arteries, all of which were heavily calcified and most of which contained bone. The frequent absence of bone in heavily calcified vessels and the histologic pattern strongly suggests a secondary rather than primary event. Recruitment of osteoclasts to vascular calcifications can occur but is rare, suggesting a limited capacity to reverse calcifications.
钙化动脉中骨组织的存在可能为钙化的病理生理学及潜在可逆性提供见解，但钙化动脉中骨和破骨细胞的患病率、分布及决定因素尚不清楚。对108例患者下肢截肢的386条动脉标本进行了回顾性检查。89例患者的282条动脉存在钙化，其中64%为中层钙化，9%为内膜钙化，27%为两者均有钙化。6%的动脉存在骨组织，基本上所有这些动脉都有严重钙化。多次采样显示，严重钙化动脉中骨组织的实际患病率为25%。骨组织在内层钙化中比在内膜钙化中更常见（10%对3%，p=0.03），但不随动脉位置（膝上与膝下）而变化。有骨组织的严重钙化动脉更可能来自年龄较大（p=0.04）、患有糖尿病（p=0.06）或正在接受华法林治疗（p=0.06）的患者，但与性别或肾衰竭无关。骨组织几乎总是沿着周边与钙化相邻，但从不位于钙化内部。在20%没有可见骨组织的严重钙化动脉中发现了骨特异性蛋白骨钙素和osterix的染色。4.9%的动脉存在破骨细胞，所有这些动脉都有严重钙化，且大多数含有骨组织。严重钙化血管中频繁缺乏骨组织以及组织学模式强烈提示这是一个继发性而非原发性事件。破骨细胞可招募至血管钙化处，但很少见，这表明逆转钙化的能力有限。
