Konishi Takao, Funayama Naohiro, Yamamoto Tadashi, Hotta Daisuke, Nomura Ryota, Nakagaki Yusuke, Murahashi Takeo, Kamiyama Kenji, Yoshimoto Tetsuyuki, Aoki Takeshi, Tanaka Shinya
Department of Cardiology, Hokkaido Cardiovascular Hospital, 1-30, West 13, South 27, Chuou-ku, Sapporo, 064-8622, Japan.
Department of Cancer Pathology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Heart Vessels. 2018 Nov;33(11):1311-1324. doi: 10.1007/s00380-018-1193-6. Epub 2018 May 22.
Human and animal studies have revealed a stabilization of atherosclerotic plaques by statins. However, the stabilization of human carotid plaques has not been thoroughly described pathologically. This analysis explored the relationship between statin therapy and plaque stability in carotid endarterectomy (CEA) specimens. We analyzed specimens harvested between May 2015 and February 2017, from 79 consecutive patients presenting with > 70% carotid artery stenoses, of whom 66 were untreated (group 1) and 13 treated (group 2) with a statin. Immunohistochemistry was performed, using an endothelial specific antibody to CD31, CD34 and platelet derived growth factor receptor-β. The prevalence of plaque ruptures (P = 0.009), lumen thrombi (P = 0.009), inflammatory cells (P = 0.008), intraplaque hemorrhages (P = 0.030) and intraplaque microvessels (P < 0.001) was significantly lower in group 2 than in group 1. Among 66 patients presenting with strokes and infarct sizes > 1.0 cm on magnetic resonance imaging, the mean infarct volume was significantly smaller (P = 0.031) in group 2 (4.2 ± 2.5 cm) than in group 1 (8.2 ± 7.1 cm). The difference in mean concentration of low-density lipoprotein cholesterol between group 1 (121 ± 32 mg/dl) and group 2 (105 ± 37 mg/dl) was non-significant (P = 0.118). This analysis of plaques harvested from patients undergoing CEA suggests that statin therapy mitigates the plaque instability, which, in patients presenting with strokes, might decrease infarct volume.
人类和动物研究表明，他汀类药物可使动脉粥样硬化斑块趋于稳定。然而，人类颈动脉斑块的稳定性在病理学上尚未得到充分描述。本分析探讨了他汀类药物治疗与颈动脉内膜切除术（CEA）标本中斑块稳定性之间的关系。我们分析了2015年5月至2017年2月间采集的标本，这些标本来自79例连续的颈动脉狭窄超过70%的患者，其中66例未接受治疗（第1组），13例接受他汀类药物治疗（第2组）。采用内皮特异性抗体CD31、CD34和血小板衍生生长因子受体-β进行免疫组织化学检测。第2组斑块破裂（P = 0.009）、管腔血栓（P = 0.009）、炎症细胞（P = 0.008）、斑块内出血（P = 0.030）和斑块内微血管（P < 0.001）的发生率显著低于第1组。在66例磁共振成像显示有中风且梗死面积大于1.0 cm的患者中，第2组（4.2±2.5 cm）的平均梗死体积显著小于第1组（8.2±7.1 cm）（P = 0.031）。第1组（121±32 mg/dl）和第2组（105±37 mg/dl）之间的低密度脂蛋白胆固醇平均浓度差异无统计学意义（P = 0.118）。对接受CEA患者的斑块进行的这项分析表明，他汀类药物治疗可减轻斑块不稳定性，这在中风患者中可能会减小梗死体积。
