Schnader J, Schloo B L, Anderson W, Stephenson L W, Fishman A P
Department of Medicine, University of Pennsylvania, Philadelphia 19104, USA.
J Surg Res. 1996 May;62(2):243-50. doi: 10.1006/jsre.1996.0202.
Scant data exist on the evolution of the lesions of pulmonary hypertension. This study establishes a model in sheep in which the left upper lobe (LUL) was rendered hypertensive by a systemic-pulmonary shunt while the rest of the pulmonary circulation remained normotensive. By examining lung tissue at 2 months and 1 1/2 years after shunting, we sought the temporal progression of pulmonary hypertensive lesions. In the hypertensive LULs (n = 5), many vascular lesions were seen in contrast to the absence of lesions in both the contralateral normotensive lungs (n = 5) and the "control" lungs from sheep which underwent thoracotomy without shunting (n = 5). Vascular necrosis and vasculitis were present after 2 months (P < 0.01) but disappeared after 1 1/2 years. In contrast, intimal thickening was present after 1 1/2 years (n = 2, P < 0.01) but not significantly after 2 months. These intimal lesions often demonstrated increased cellularity staining positively for factor VIII. Plexiform lesions were present at 2 months (P < 0.05) but were more profuse after 1 1/2 years (P < 0.01). These findings are consistent with an early vascular injury and a later remodeling or reparative process in hemodynamic pulmonary hypertension.
关于肺动脉高压病变的演变，现有数据很少。本研究在绵羊中建立了一个模型，通过体肺分流使左上叶（LUL）血压升高，而肺循环的其余部分保持正常血压。通过在分流后2个月和1.5年检查肺组织，我们探寻肺动脉高压病变的时间进展。在高血压的左上叶（n = 5）中，可见许多血管病变，相比之下，对侧正常血压的肺（n = 5）和未进行分流而仅接受开胸手术的绵羊的“对照”肺（n = 5）中均无病变。2个月后出现血管坏死和血管炎（P < 0.01），但在1.5年后消失。相比之下，1.5年后出现内膜增厚（n = 2，P < 0.01），但在2个月后不明显。这些内膜病变通常显示细胞增多，对因子VIII呈阳性染色。丛状病变在2个月时出现（P < 0.05），但在1.5年后更为丰富（P < 0.01）。这些发现与血流动力学性肺动脉高压早期的血管损伤以及后期的重塑或修复过程一致。
