摘要
目的探讨脑动静脉畸形（brain arteriovenous malformation,BAVM）病灶周围毛细血管的病理组织形态学变化,并推测其在BAVM病理生理过程中的临床意义。方法选取病灶周围有足够脑组织（5-10mm）的10例BAVM手术标本,行常规HE染色及透射电镜观察。再行VIII因子免疫组织化学染色标记血管,以北航CMIAS图像分析系统测量分析毛细血管直径、圆度、数密度、体积密度和面积密度。取10例原发性癫病人的手术标本为对照。结果HE染色结果表明BAVM病灶周围毛细血管显著扩张;透射电镜观察见畸形血管团周边的毛细血管管壁结构受到一定程度的破坏,表现为一种慢性缺血、缺氧性改变;体视学测量结果表明畸形血管团周围毛细血管直径为（0.1496±0.0389）mm;与对照组（0.0274±0.0185）mm相比,差异具有统计学意义（t=8.974,P〈0.001）;畸形血管团周围毛细血管数密度与对照组相比亦显著性增高（t=2.977,P〈0.01）,其数值分别为0.4200±0.1476和0.2600±0.0843;BAVM组毛细血管面积密度与对照组相比也存在统计学差异,其数值分别为0.0114±0.0086和0.0040±0.0018（t=2.638,P〈0.05）;BAVM组体积密度0.0092±0.0044与对照组0.0045±0.0051相比差异具有统计学意义（t=2.2066,P〈0.05）。结论BAVM血管团周围脑组织表现为一种慢性缺血、缺氧性改变。畸形血管团周围毛细血管分布密度增高并显著扩张。这些异常的毛细血管可能是BAVM潜在组成部分,在畸形团切除术后脑水肿发生、残腔出血以及BAVM再生发病机制中可能具有重要作用。
Objective Through exploring the blood capillary pathological features and stereoscopy measurement of immediate perinidal parenchyma in brain arteriovenous malformations to understand the pathologic histomorphological change regularity and presume the clinical sense. Methods The study was conducted using excised BAVM specimens fulfilled the criteria for sufficient brain tissue around the excised nidus （5 - 10 mm）. Specimens were stained with hematoxylin and eosin, and the immediate perinidal microvascular environment was examined using transmission electron microscope. Paraffin sections were randomly selected from each specimen for VIII factor immunohistochemistry stain, which impressed relatively specific on the blood capillary endothelial cells. Selected 10 cases with essential epilepsy specimens as control group. Results 10 eases of the BAVMs showed the presence of dilated capillaries, and perieapillary space widened. Some eases showed RBCs escaped to the surrounding brain tissue around these dilated capillaries. Other pathological changes were detected in all cases of the perinidal parenchymas studied, including degenerating neurons and brain edema, these findings were absent in control specimens. The brain parenchyma presented the chronic change of ischemia and hypoxia. Results of transmission electro microscopy showed the presence of chronic pathological change, including destroyed vascular wall perinidus, vessel swelling, vacuole phenomenon, endothelial tight junction and cytoplasm lost, brain edema and myelin sheath lost. Results of stereoscopy measurement showed the blood capillaries diameter perinidus averaged was （0. 1496 ± 0. 0389） mm, contrast to normal group （0. 0274 ±0. 0185） mm, the difference was significant（t = 8.974,P 〈0. 001 ）. There were no significant difference between perinidus capillaries and normal capillaries in circular degree（t = 1. 378 ,P =0. 185）. The number density of perinidus capillaries were significant higher those in control group（ t = 2. 977 ,P 〈 0.
出处
《中国神经精神疾病杂志》
CAS
CSCD
北大核心
2007年第6期325-329,共5页
Chinese Journal of Nervous and Mental Diseases
