【作者】 王斌；

【导师】 游潮；

【作者基本信息】 四川大学 ， 外科学， 2007， 硕士

【摘要】 目的：1．观察人脑囊性动脉瘤壁的组织病理学及结构变化；2．检测COX-2、VEGF在人脑囊性动脉瘤壁中的表达，探讨脑动脉瘤的发病机制。方法：收集四川大学华西医院神经外科于2005年11月～2006年10月经开颅手术、术中夹闭动脉瘤颈后切除所得的34例临床标本；所有动脉瘤标本均在保证患者生命和手术安全的情况下获取；其中男12例，女22例。10例对照组正常动脉包括颞浅动脉2例、脑皮层动脉6例、大脑前动脉和大脑中动脉分支各1例，标本取自我科同期行脑内血肿清除、内减压术的病人。1．对34例人脑囊性动脉瘤和10例对照组动脉标本进行肉眼大体观察及光镜观察；2．应用免疫组化SP法检测COX-2、VEGF在34例人脑囊性动脉瘤壁和10例对照组动脉壁中的表达情况。结果：1．肉眼大体观察：本组病例动脉瘤体多呈紫红色、暗蓝色或间有棕褐色，部分可见动脉粥样硬化斑块；部分动脉瘤瘤腔内有血栓附着，有的松软，有的脆硬，也可见陈旧性出血；瘤壁厚薄不一，基底部较顶部厚，有的顶部仅剩一层薄的膜状组织，甚至已经破裂。2．光镜观察：(1)HE染色：所有动脉瘤壁的三层结构均已经部分或全部破坏，管壁结构异常。动脉瘤管壁厚薄明显不均，全层或局部区域显著变薄向外膨出，内皮细胞空泡变性或坏死脱落，部分内皮细胞剥离并突入管腔成游离状，可见血栓形成及部分血栓机化；内弹力板变薄、消失或突然中断；在内膜及中膜部位主要为纤维母细胞、纤维细胞和大片胶原；部分动脉瘤壁呈均质状玻璃样变，平滑肌细胞明显减少；中膜和外膜可见大量的炎性细胞浸润；瘤壁组织有纤维母细胞、纤维细胞、大片胶原成分及较多泡沫细胞，胞浆内充满脂类物质及胆固醇结晶；部分动脉瘤腔内充满血栓，有的血拴已经纤维化，血栓基部机化，血栓表面有红细胞和纤维素。(2)弹力纤维染色：脑动脉瘤壁内弹力膜几乎完全消失，在大动脉瘤壁外膜的新生小血管可见内完整弹力膜；动脉瘤壁几乎全部是排列紊乱的胶原纤维，部分动脉瘤壁内可见少许弹力纤维。对照组动脉壁的内弹力膜完整，胶原排列整齐。3．免疫组化染色：COX-2在人脑囊性动脉瘤壁高表达，在对照组动脉壁表达较低或无表达，差异有统计学意义；在动脉瘤壁的内膜、中膜和外膜中均表达，差异无统计学意义。VEGF在人脑囊性动脉瘤壁高表达，在对照组动脉壁表达较低或无表达，差异有统计学意义；在动脉瘤壁的内膜、中膜和外膜中均表达，差异无统计学意义。结论：1．人脑囊性动脉瘤壁的病理学改变主要是动脉瘤壁内弹力膜和弹力纤维的破坏或消失，胶原纤维溶解，平滑肌细胞数目减少或消失，炎性细胞侵润，导致动脉瘤壁基质结构的严重破坏，抗张力强度降低。2．COX-2在人脑囊性动脉瘤壁高表达，在对照组动脉壁表达较低或无表达，差异有统计学意义；在动脉瘤壁的内膜、中膜和外膜中均表达，差异无统计学意义。3．VEGF在人脑囊性动脉瘤壁高表达，在对照组动脉壁表达较低或无表达，差异有统计学意义；在动脉瘤壁的内膜、中膜和外膜中均表达，差异无统计学意义。更多还原

【Abstract】 Objective: 1.To observe the tissue pathology and structure change in human cerebal saccular aneurysm. 2.To detect the the expression of C0X-2、VEGF in human cerebal saccular aneurysm and explore the pathogenesis of aneurysm.Methods: Thirty-four surgical specimens of human cerebal aneurysm from 12 males and 22 femals in Huaxi Hospital Sichuan University during 2005.11～2006.10. were choosen. All specimens were got from dissecting after clipping the aneurysm in craniotomy with the guarantee of protecting patient and operation safty. Ten control specimens included 2 cases suferficial artery, cortex artery 6, 1 anterior cerebral artery and 1 middle cerebral artery. These specimens came from hematoma removal and internal decompression. l.To observe the all spicimens with naked eyes and lightscope. 2.To detect the expression of COX-2、VEGF in huaman cerebral saccular aneurysm with sp immunohistochemical method.Results: 1.Naked eyes obervation: Most of the specimens were purple, dark blue or brown, Atherosclerosis plaques could be seen in some of the aneurysmal specimens. There were thrombosis in some cavities of the aneurysms, some were soft, some crisp. Chronic bleeding could also be seen. The wall of the aneurysm varied, the bottom was thicker than the top. Sometimes, only a thin membrane at the top of the aneurysm was left, even ruptured. 2.Lightscope observation: (1)HE staining: All three elements of the aneurysmal wall were damaged totally or partially. The wallof the vessels were abnormal. The thickness of aneurysmal wall was various, the all layers or local region became thin and extended outside, the endothelial cells were bulb degeneration or necrosis. Some cell dropped into the cavity and became free. Thrombosis or part organization could be seen. The internal elastic layer became thin, disappear or broken. In internal and middle layer existed fibroblasts, fibrocytes and collagen. Some of the wall indicated hyaline change, soomth muscle cell decreased greatly. The massive inflammatory cells invaded the middle and external layer. There were many foam cells in the capsule tissue. Cytoplasm was filled with fatty tissue and cholesterol. some cavities were full of thrombosis. Some thrombosis was fibrosis, the bottom was organization. The surface of the thrombosis existed red blood cell and librae. (2)Elatic fibrila staining: the internal elastic menbrane almost completely disappeared, the intact internal elastic menbran could be seen in the new small vessels. The aneurismal wall were all disordered collagen fibrils. Some collagen fibrils could be found inside the wall. The controlled group indicated low expression or lacked. The difference was statistically significant. The positive rate in internal layer was lower than middle and external layers. No statistical significance. 3.The sp immunhistochemistry staining: The high expressin of COX-2 in human cerebal saccular aneurysmal walls comparing the low expression of in controlled group indicated the statistical significance. COX-2 expressed in internal, middle and external membrane. No statistical significance anong them. The high expressin of VEGF in human cerebal saccular aneurysmal walls comparing the low expression in controlled group indicated the statistical significance. VEGF expressed in internal,middle and external membrane, but there was no statistical significance.Conclusion: 1.The main chang in human cerebal saccular aneurysm lies in the damage or dissappear if the internal elastid menbrane and elastic fibrils, the dissoving of collagen fibrils, the decreasing or dissappeared soomth muscle cells, the inflammatory cells invasion, which leads to the severe damage of matrix layers, decreased the resistant tension. 2.The high expressin of COX-2 in human cerebal saccular aneurysmal walls comparing the low expression of in controlled group indicated the statistical significance. COX-2 expressed in internal, middle and external membrane. No statistical significance anong them. 3.The high expressin of VEGF in human cerebal saccular aneurysmal walls comparing the low expression in controlled group indicated the statistical significance. VEGF expressed in internal, middle and external membrane, but there was no statistical significance.更多还原