Ak Esin, Ak Koray, Midi Ahmet, Kervancıoğlu-Demirci Elif, Arsan Sinan, Çetinel Şule, Pişiriciler Rabia
Department of Basic Medical Sciences, Histology and Embryology, Faculty of Dentistry, Marmara University, Istanbul, Turkey.
Department of Cardiovascular Surgery, Faculty of Medicine, Marmara University, Istanbul, Turkey.
Cardiovasc Pathol. 2021 May-Jun;52:107328. doi: 10.1016/j.carpath.2021.107328. Epub 2021 Feb 24.
Diabetes Mellitus (DM) has been known to be a risk factor for the development of more severe form of saphenous vein graft disease after coronary artery bypass grafting (CABG). We aimed to evaluate the impact of type II-DM on histopathological features of great saphenous vein grafts of patients undergoing CABG.
Forty consecutive patients undergoing elective CABG were enrolled into the study. Patients were grouped into two; Diabetic group (n = 20); includes patients with preoperative diagnosis of type II-DM and Nondiabetic group (n = 20): those without type II-DM. In all patients, a short segment of the great saphenous vein graft at the level of medial malleolus was taken for light microscopy and transmission electron microscopy (TEM) evaluation. Moreover, immunoexpressions of Caveolin-1, Vascular cell adhesion protein 1 (VCAM-1) and endothelial nitric oxide synthase (eNOS) were studied.
There were no differences in the demographics of patients between two groups. The magnitude of intimal fibrosis in diabetic group was slightly higher than in nondiabetics (1.95 ± 0.99 versus 1.3 ± 0.8, P = .04). In TEM, vacuolization in endothelial cells, substance accumulation along with coarse collagen fibers and cytoplasmic degeneration with vacuolization in muscle cells were detected in diabetic group. While there were no differences in Caveolin-1 and VCAM-1 immunostaining, the intensity of positive eNOS immunostaining was significantly higher in endothelium (2.10 ± 0.64 versus 1.55 ± 0.68, P = .01) and tunica media 1.75 ± 0.63 versus 1.2 ± 0.52, P = .007) in nondiabetic group, respectively) compared with diabetic group.
Type II DM might be a reason for decreased expression of eNOS and increased intimal fibrosis, vacuolization of endothelial and smooth muscle cells in saphenous vein grafts. The clinical implications of these alterations on the graft patency need to be evaluated.
糖尿病（DM）已知是冠状动脉旁路移植术（CABG）后隐静脉移植物疾病更严重形式发展的一个危险因素。我们旨在评估II型糖尿病对接受CABG患者大隐静脉移植物组织病理学特征的影响。
连续40例接受择期CABG的患者纳入本研究。患者分为两组；糖尿病组（n = 20）；包括术前诊断为II型糖尿病的患者和非糖尿病组（n = 20）：那些没有II型糖尿病的患者。在所有患者中，在内踝水平取一段短的大隐静脉移植物用于光学显微镜和透射电子显微镜（TEM）评估。此外，研究了小窝蛋白-1、血管细胞粘附蛋白1（VCAM-1）和内皮型一氧化氮合酶（eNOS）的免疫表达。
两组患者的人口统计学特征没有差异。糖尿病组内膜纤维化程度略高于非糖尿病组（1.95±0.99对1.3±0.8，P = 0.04）。在TEM中，糖尿病组检测到内皮细胞空泡化、物质积聚以及粗胶原纤维，肌肉细胞出现细胞质变性伴空泡化。虽然小窝蛋白-1和VCAM-1免疫染色没有差异，但与糖尿病组相比，非糖尿病组内皮中eNOS阳性免疫染色强度显著更高（2.10±0.64对1.55±0.68，P = 0.01），中膜分别为1.75±0.63对1.2±0.52，P = 0.007）。
II型糖尿病可能是隐静脉移植物中eNOS表达降低、内膜纤维化增加、内皮和平滑肌细胞空泡化的原因。这些改变对移植物通畅性的临床意义需要评估。
