摘要目的研究门静脉高压症患者内脏血管壁的病理形态学改变.方法 50例门静脉高压症患者在行脾切除和贲门周围血管离断术时,取脾动脉、静脉和胃冠状静脉,行光镜和电镜观察.免疫组化法分析脾动脉壁诱导型一氧化氮合成酶(iNOS)的表达.结果脾动脉的内弹力膜和中膜内弹力纤维断裂和变性.脾动脉平滑肌细胞可见萎缩、凋亡和表型改变.平滑肌细胞的胞浆内可见iNOS阳性表达.肝硬化患者可见内脏静脉内膜增生,静脉壁有广泛的附壁血栓,类粥样硬化斑块形成,平滑肌细胞肥大,静脉肌纤维明显增粗和增厚,管壁细胞外基质增加.结论门静脉高压症可合并内脏动脉和静脉的血管病变,在门静脉高压症的发病机制中,门静脉高压、内脏高动力循环和内脏血管病变之间具有相互影响的关系.

abstractsObjective To investigate the pathological morphology alteration of the splanchnic vascular wall in portal hypertensive patients.Methods Splenic arteries, veins and gastric coronary veins from portal hypertensive patients (n=50) were removed during esophagogastric devascularization with splenectomy and were observed under optic and electron microscopes. The expression of iNOS in the splenic artery wall was analysed with immunohistochemistry.Results The internal elastic membrane and medial elastic fibers of the splenic artery wall were broken and degenerated. Atrophy, apoptosis and phenotypic changes were seen in smooth muscle cells of splenic arteries. Positive staining for iNOS was seen in the cytoplasm of smooth muscle cells and iNOS activity was elevated compared with the non-cirrhotic patients (P<0.01). In the splenic and gastric coronary veins of cirrhotic patients, we found proliferative intima, extensive thrombi adhering to the venous wall, mimicked arteriosclerosis plaques accompanied with hypertrophy of smooth muscle cells, and thickened muscle fibers of veins with increase in extracelluar matrix.Conclusion Portal hypertension may be complicated by splanchnic arterial and venous vasculopathy. There may be an interactive relationship among portal hypertension, splanchnic hyperdynamic disturbances and splanchnic vasculopathy in the pathogenesis of portal hypertension.