Farb A, Burke A P, Tang A L, Liang T Y, Mannan P, Smialek J, Virmani R
Department of Cardiovascular Pathology, Armed Forces Institute of Pathology, Washington, DC 20306-6000, USA.
Circulation. 1996 Apr 1;93(7):1354-63. doi: 10.1161/01.cir.93.7.1354.
Coronary thrombosis has been reported to occur most frequently in lipid-rich plaques with rupture of a thin fibrous cap and contact of the thrombus with a pool of extracellular lipid. However, the frequency of coronary artery thrombosis with or without fibrous cap rupture in sudden coronary death is unknown. In this study, we compared the incidence and morphological characteristics of coronary thrombosis associated with plaque rupture versus thrombosis in eroded plaques without rupture.
Fifty consecutive cases of sudden death due to coronary artery thrombosis were studied by histology and immunohistochemistry. Plaque rupture of a fibrous cap with communication of the thrombus with a lipid pool was identified in 28 cases. Thrombi without rupture were present in 22 cases, all of which had superficial erosion of a proteoglycan-rich plaque. The mean age at death was 53 +/- 10 years in plaque rupture cases versus 44 +/- 7 years in eroded plaques without rupture (P < .02). In the plaque-rupture group, 5 of 28 (18%) were women versus 11 of 22 (50%) with eroded plaques (P = .03). The mean percent luminal area stenosis was 78 +/- 12% in plaque rupture and 70 +/- 11% in superficial erosion (P < .03). Plaque calcification was present in 69% of ruptures versus 23% of erosions (P < .002). In plaque ruptures, the fibrous cap was infiltrated by macrophages in 100% and T cells in 75% of cases compared with 50% (P < .0001) and 32% (P < .004), respectively, in superficial erosions. Clusters of smooth muscle cells adjacent to the thrombi were present in 95% of erosions versus 33% of ruptures (P < .0001). HLA-DR expression was more often seen in macrophages and T cells in ruptures (25 of 28 cases) compared with expression in macrophages in superficial erosion arteries (8 of 22 cases, P = .0002).
Erosion of proteoglycan-rich and smooth muscle cell-rich plaques lacking a superficial lipid core or plaque rupture is a frequent finding in sudden death due to coronary thrombosis, comprising 44% of cases in the present study. These lesions are more often seen in younger individuals and women, have less luminal narrowing and less calcification, and less often have foci of macrophages and T cells compared with plaque ruptures.
据报道，冠状动脉血栓形成最常发生于富含脂质的斑块，伴有薄纤维帽破裂，且血栓与细胞外脂质池接触。然而，在心脏性猝死中，伴或不伴有纤维帽破裂的冠状动脉血栓形成的发生率尚不清楚。在本研究中，我们比较了与斑块破裂相关的冠状动脉血栓形成和未破裂糜烂斑块中血栓形成的发生率及形态学特征。
通过组织学和免疫组织化学研究了连续50例因冠状动脉血栓形成导致的猝死病例。28例发现有纤维帽破裂且血栓与脂质池相通。22例存在无破裂的血栓，所有这些病例均有富含蛋白聚糖的斑块表面糜烂。斑块破裂病例的平均死亡年龄为53±10岁，而未破裂糜烂斑块病例为44±7岁（P<0.02）。在斑块破裂组中，28例中有5例（18%）为女性，而在糜烂斑块组中22例中有11例（50%）为女性（P = 0.03）。斑块破裂时管腔面积狭窄的平均百分比为78±12%，表面糜烂时为70±11%（P<0.03）。69%的破裂斑块有斑块钙化，而糜烂斑块中为23%（P<0.002）。在斑块破裂中，100%的病例纤维帽中有巨噬细胞浸润，75%有T细胞浸润，相比之下，表面糜烂中分别为50%（P<0.0001）和32%（P<0.004）。与血栓相邻的平滑肌细胞簇在95%的糜烂斑块中存在，而在破裂斑块中为33%（P<0.0001）。与表面糜烂动脉中的巨噬细胞表达相比，HLA-DR表达在斑块破裂中的巨噬细胞和T细胞中更常见（28例中有25例）（22例中有8例，P = 0.0002）。
在因冠状动脉血栓形成导致的猝死中，富含蛋白聚糖和平滑肌细胞、缺乏表面脂质核心或斑块破裂的糜烂是常见发现，在本研究中占44%的病例。与斑块破裂相比，这些病变在年轻个体和女性中更常见，管腔狭窄和钙化较少，巨噬细胞和T细胞灶也较少见。
