淀粉样脑血管病相关性脑出血的病理研究

摘要

Objective To study the prevalence and neuropathological characteristics of cerebral amyioid angiopathy hemorrhage( CAAH )in spontaneous intracerebral hemorrhage( SICH ) patients of Xinjiang minority areas.Methods From May 2009 to March 2011,124 patients admitted to six hospitals throughtout Xinjiang for acute SICH.The patients were suffered from SICH proved by computed tomography scan(CT).Emergent craniotomy for hemorrhage evacuation were performed for those patients within 72 h after hemorrhage onset and brain tissue around the hematoma was also obtained for histological examination through HE dyed 、Congo Red stained under polarized light microscope and Aβ immunochemistry to verify the existence of CAA.Results 11 patients were identified as CAAH and the total ratio was 8.9％.Among which 4 cases were congophilic angiopathy,1 plaque - like angiopathy,6 mixed type.Conclusions 8.9％SICH are associated with CAA in Xinjiang minority areas.The vessel walls of CAA become thickening and the normal vessel structures disappear.β -amyloid protein is mainly deposited in small arteries,middle and outer membrane.In some patients,β -amyloid protein is deposited in brain.%目的 研究新疆少数民族地区自发性脑出血患者中淀粉样脑血管病相关性脑出血(CAAH)的比例及其病理特点.方法 经头颅CT证实为自发性脑出血的124例患者来自于有代表性的南北疆6家三级甲等医院,入组患者接受开颅手术,标本取白血肿腔周围,通过HE染色、刚果红染色偏振光显微镜观察、β淀粉样蛋白(Aβ)免疫组化检测明确是否存在脑血管淀粉样变性.结果124例患者中11例为CAAH,占8.9％,其中4例为嗜刚果红血管病,1例表现为斑样血管病,6例为混合型.结论 新疆少数民族地区手术治疗的自发性脑出血患者中8.9％与淀粉样脑血管病(CAA)相关,其比例随年龄增加；CAA表现为受累的血管壁增厚,血管壁正常结构消失,淀粉样物质在血管被膜中层和外膜中沉积；部分患者脑实质内可见β淀粉样蛋白沉积.