冠脉循环微血管病变与老年高血压左室肥厚患者的心脏事件

目的　探讨老年高血压左室肥厚患者冠脉循环微血管病理改变与心脏事件的关系。方法　从我院 195 4～1996年间连续尸检 3195例的心脏标本中选取≥ 6 0岁 ,经临床和病理证实的高血压患者共 15 8例 (高血压 71例 ,高血压合并冠心病 6 2例 ,高血压合并冠心病和糖尿病 2 5例 )进行下列测定 :(1)左室肥厚 (LVH)分级 ;(2 )冠状动脉粥样硬化 (CAS)狭窄分级 ;(3)主动脉粥样硬化 (AAS)分级 ;(4)心肌微动脉密度 :直径 10～ 6 0 μm有内弹力板的心肌微动脉数 ;(5 )心肌微动脉壁腔比值 ;(6 )心肌毛细血管密度及其内皮细胞面积。结果　本组病理资料Logistic分析证实 ,老年高血压左室肥厚患者心脏事件的影响因素 ,按相关程度高低依次为心肌微动脉壁腔比值 (r =0 .1783,P=0 .0 0 5 5 ,OR=12 .72 0 4) ,CAS (r=0 .1738,P =0 .0 0 6 4,OR=2 .340 9) 及心肌微动脉密度 (r=- 0 .12 2 3,P=0 .0 30 4,OR =0 .6 10 1)。结论　冠脉循环微动脉病变程度及CAS程度是影响老年高血压左室肥厚患者心脏事件发生率的主要因素 ,应引起进一步重视

Pathological changes in microvessels of coronary circulation and cardiac events in old hypertensive patients with left ventricular hypertrophy

Objective To investigate the factors contributing to cardiac event in essential hypertension(EHT) with left ventricular hypertrophy(LVH) in elderly cases.Methods A retrospective study was performed in 158 cases of EHT with LVH over 60 years old out of 3?195 consecutive autoptic cases from 1954 to 1996.Of the 158 cases,71 had EHT,62 had EHT and CHD,25 had EHT,CHD and NIDD.In all the cases the following parameters were measured:(1)The degree of LVH:According to the free wall thickness(WT) of left ventricle,the LVH was classified into 4 degrees:LVHⅠ,WT 12～15 mm;LVHⅡ,16～20 mm;LVHⅢ,>20 mm,and 0,<12 mm(no LVH);(2)The grade of coronary atherosclerosis(CAS):According to the narrowing percentage of transection(NAT) of main coronary artery branches,the severity of CAS was estimated as 4 grades:CASⅠ,NAT<25%;CAS Ⅱ,25%～50%;CAS Ⅲ,50%～75%;CAS Ⅳ,>75%;(3)The grade of aortic atherosclerosis(AAS):According to the plaque area as percentage of aortic intimal area,the severity of AAS was estimated as 4 grades:AASⅠ,<25%;AASⅡ,25%～50%;AASⅢ,50%～75%;AAS Ⅳ,>75%;(4)Arteriole density(AD) of myocardium:The arterioles with diameter of 10～60 μm in sections of left ventricle were stained for elastic fiber +VG stain and AD was measured with light microscope and computer;(5)The ratio of wall to lumen(RWL) of myocardial arteriole;(6)The capillary density(CD) and its endothelial cell area(AEC) in myocardium.Result The factors significantly contributing to cardiac events in this study in order of decreasing degree of correlation were,RWL (r=0.1783,P=0.0055),CAS(r=0.1738,P=0.0064) and AD (r=-0.1223,P=0.0304).Conclusion The result suggested that the cardiac events in our cases with LVH correlated strongly with the severity of microvascular damage and the grade of CAS,to which further attention should be paid in treatment of EHT with LVH in the elderly.