Davies M J, Richardson P D, Woolf N, Katz D R, Mann J
British Heart Foundation, Cardiovascular Pathology Unit, St George's Hospital Medical School, London.
Br Heart J. 1993 May;69(5):377-81. doi: 10.1136/hrt.69.5.377.
To assess the size of the lipid pool and the number of smooth muscle cells and monocyte/macrophages in human aortic plaques that were intact and to compare the results with those in aortic plaques undergoing ulceration and thrombosis.
The lipid pool was measured as a percentage of the total cross sectional area of the plaque. Immunohistochemistry was used to identify cell types (monocytes/macrophages (M phi) by EBM11 and HAM56, smooth muscle cells by alpha actin). The area of the tissue occupied by each cell type was measured by quantitative microscopy in the peripheral (shoulder) area of the plaque and the plaque cap. Absolute counts of each cell type were expressed as the ratio of SMC:M phi.
Aortas were obtained at necropsy from men aged less than 69 years who died suddenly (within 6 hours of the onset of symptoms) of ischaemic heart disease. 155 plaques from 13 aortas were studied. Four aortas showed intact plaques only (group A, n = 31). Nine aortas showed both intact plaques (group B, n = 79) and plaques that were undergoing thrombosis (group C, n = 45).
In 41 (91.1%) of the 45 plaques undergoing thrombosis (group C) lipid pools occupied more than 40% of the cross sectional area of the plaque. Only 12 (10.9%) of the 110 intact plaques (groups A + B) had lipid pools of this size. The mean size of the lipid pool in plaques of groups A, B, and C was 12.7%, 27.3% and 56.7% respectively. Compared with intact plaques those undergoing thrombosis contained a smaller volume of smooth muscle cells (2.8% v 11.8%) and a larger volume of monocyte/macrophages (13.7% v 2.9%) in the plaque cap. The ratio of the number of smooth muscle cells to monocytes/macrophages was 7.8 in group A plaques, 4.1 in group B plaques, and 1.0 in group C plaques. This gradient was the result of an absolute increase in monocyte/macrophages and an absolute decrease in smooth muscle cells.
In the aorta ulceration and thrombosis were characteristic of plaques with a high proportion of their volume occupied by extracellular lipid, and in which there was a shift toward a preponderance of monocyte/macrophages compared with smooth muscle cells in the cap.
评估完整的人体主动脉斑块中脂质池的大小、平滑肌细胞及单核细胞/巨噬细胞的数量，并将结果与发生溃疡和血栓形成的主动脉斑块进行比较。
脂质池以占斑块总横截面积的百分比来衡量。采用免疫组织化学方法识别细胞类型（通过EBM11和HAM56识别单核细胞/巨噬细胞（M phi），通过α肌动蛋白识别平滑肌细胞）。通过定量显微镜测量每种细胞类型在斑块周边（肩部）区域和斑块帽中所占的组织面积。每种细胞类型的绝对计数以平滑肌细胞：单核细胞/巨噬细胞的比例表示。
尸检时从年龄小于69岁、因缺血性心脏病突然死亡（症状发作后6小时内）的男性获取主动脉。研究了来自13个主动脉的155个斑块。4个主动脉仅显示完整斑块（A组，n = 31）。9个主动脉既显示完整斑块（B组，n = 79）又显示正在发生血栓形成的斑块（C组，n = 45）。
在45个正在发生血栓形成的斑块（C组）中，41个（91.1%）的脂质池占斑块横截面积的40%以上。在110个完整斑块（A组+B组）中，只有12个（10.9%）有如此大小的脂质池。A组、B组和C组斑块中脂质池的平均大小分别为12.7%、27.3%和56.7%。与完整斑块相比，正在发生血栓形成的斑块在斑块帽中平滑肌细胞体积较小（2.8%对11.8%），单核细胞/巨噬细胞体积较大（13.7%对2.9%）。A组斑块中平滑肌细胞与单核细胞/巨噬细胞数量的比例为7.8，B组斑块为4.1，C组斑块为1.0。这种梯度是单核细胞/巨噬细胞绝对增加和平滑肌细胞绝对减少的结果。
在主动脉中，溃疡和血栓形成是斑块的特征，这些斑块细胞外脂质占其体积的比例较高，且斑块帽中与平滑肌细胞相比单核细胞/巨噬细胞占优势。
