Asada Y, Sumiyoshi A, Hayashi T, Suzumiya J, Kaketani K
Thromb Res. 1985 Jun 1;38(5):469-79. doi: 10.1016/0049-3848(85)90180-x.
We collected 23 autopsied cases of thrombotic thrombocytopenic purpura (TTP) and examined them immunohistochemically and electronmicroscopically to elucidate the nature of thrombi and subendothelial deposits. The findings were compared with those of 10 cases of disseminated intravascular coagulation (DIC) and 3 cases of polyarteritis nodosa (PN). Intravascular thrombi and subendothelial hyaline deposits in TTP stained weakly for fibrinogen/fibrin by the PAP technique, while they stained strongly for factor VIII related antigen (FVIIIR: Ag). Electronmicroscopically, thrombi in TTP were composed of numerous, variably degranulated and altered platelets, and a small amount of amorphous materials. Thrombi in DIC were strongly positive for fibrinogen/fibrin, while they were weakly positive for FVIIIR:Ag. Electronmicroscopically they were composed of polymerized fibrin. Fibrinoid necrotic lesions in PN were strongly positive for fibrinogen/fibrin but negative for FVIII R:Ag. Based on these findings, we concluded that thrombi in TTP are essentially platelet thrombi and that subendothelial hyaline deposits may not be a result of increased vascular permeability but may be platelet thrombi incorporated into the arterial wall and covered with newly formed endothelial cells.
我们收集了23例血栓性血小板减少性紫癜（TTP）尸检病例，并对其进行免疫组化和电镜检查，以阐明血栓及内皮下沉积物的性质。将这些结果与10例弥散性血管内凝血（DIC）病例和3例结节性多动脉炎（PN）病例的结果进行比较。采用PAP技术，TTP中的血管内血栓及内皮下透明沉积物对纤维蛋白原/纤维蛋白染色较弱，而对因子VIII相关抗原（FVIIIR:Ag）染色较强。电镜下，TTP中的血栓由大量不同程度脱颗粒和变性的血小板以及少量无定形物质组成。DIC中的血栓对纤维蛋白原/纤维蛋白呈强阳性，而对FVIIIR:Ag呈弱阳性。电镜下它们由聚合的纤维蛋白组成。PN中的纤维蛋白样坏死病变对纤维蛋白原/纤维蛋白呈强阳性，但对FVIII R:Ag呈阴性。基于这些发现，我们得出结论，TTP中的血栓本质上是血小板血栓，内皮下透明沉积物可能不是血管通透性增加的结果，而是融入动脉壁并被新形成的内皮细胞覆盖的血小板血栓。
