Lin H, Wilson J E, Kendall T J, Radio S J, Cornhill F J, Herderick E, Winters G L, Costanzo M R, Porter T, Thieszen S L
Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada.
J Heart Lung Transplant. 1994 Sep-Oct;13(5):824-33.
Previous angiographic observations have characterized transplant atherosclerosis as a generally diffuse and more distally severe disease with obliteration of secondary branches. However, it has not been firmly established that the disease is structurally and biologically more severe distally. We evaluated this hypothesis with computer-based digitization of subserial segments of the entire perfusion-fixed left anterior descending coronary artery (100 mm Hg for 1 hour with 10% formaldehyde solution) in 25 allografts at autopsy or explant (19 male and 6 female patients; mean age = 50 years, range 16 to 66; mean implant duration = 490 days, range 3 to 1610). The area, thickness, circumference of the intima and media, and the relative and absolute luminal narrowing were evaluated in a mean of 10 left anterior descending coronary artery sections per allograft. The percentage of luminal narrowing (intimal area/[intimal area + luminal area] x 100) was similar between proximal and distal segments of the left anterior descending coronary artery (45% versus 41%, p > 0.05), and the mean absolute intimal thicknesses (in millimeters) of proximal and distal segments of the left anterior descending coronary artery also were not different (0.32 versus 0.22, p > 0.05). In addition, the 95% confidence intervals for intimal thicknesses of proximal and distal segments were comparable. Because the absolute arterial size of proximal segments is naturally larger than that of distal segments (external diameter 9.37 versus 6.79, p < 0.0001), an appearance of progressive tapering may be visualized angiographically, even though the biologic severity of the disease is geographically uniform. Similarly, observations of obliterated secondary branches in distal segments may result from naturally smaller distal luminal areas which may be occluded by less intimal thickening than would be required proximally. These data emphasize that transplant atherosclerosis is biologically uniform from proximal to distal locations. Etiologic and pathogenetic studies on proximal or distal segments should be equally informative.
以往的血管造影观察结果表明，移植血管动脉粥样硬化通常表现为弥漫性疾病，且在更远端更为严重，伴有二级分支闭塞。然而，目前尚未确凿证实该疾病在结构和生物学上在远端更为严重。我们在25例同种异体移植心脏尸检或切除标本（19例男性和6例女性患者；平均年龄 = 50岁，范围16至66岁；平均植入时间 = 490天，范围3至1610天）中，通过对整个灌注固定的左前降支冠状动脉（用10%甲醛溶液在100 mmHg下灌注1小时）的亚连续节段进行基于计算机的数字化分析，对这一假说进行了评估。对每个同种异体移植心脏平均10个左前降支冠状动脉节段的内膜和中膜面积、厚度、周长以及相对和绝对管腔狭窄情况进行了评估。左前降支冠状动脉近端和远端节段的管腔狭窄百分比（内膜面积/[内膜面积 + 管腔面积]×100）相似（45%对41%，p>0.05），左前降支冠状动脉近端和远端节段的平均绝对内膜厚度（以毫米为单位）也无差异（0.32对0.22，p>0.05）。此外，近端和远端节段内膜厚度的95%置信区间具有可比性。由于近端节段的动脉绝对尺寸自然大于远端节段（外径9.37对6.79，p<0.0001），即使该疾病的生物学严重程度在空间上是均匀的，血管造影仍可能显示出逐渐变细的外观。同样，远端节段二级分支闭塞的观察结果可能是由于远端管腔面积自然较小，与近端相比，内膜增厚较少即可导致管腔闭塞。这些数据强调，移植血管动脉粥样硬化在近端至远端的生物学特征是一致的。对近端或远端节段进行病因和发病机制研究应同样具有参考价值。
