摘要目的:探讨静脉曲张的组织学和细胞学改变以及c-fos上调与血管平滑肌细胞(VSMCs)表型转换的关系。方法:2019年1月至6月纳入复旦大学附属华东医院31例静脉曲张患者(曲张静脉组)和12例冠状动脉搭桥术的患者(正常静脉组)纳入研究，采集大隐静脉进行实验。实时定量聚合酶链反应、免疫组织化学方法检测c-fos的表达。原代培养VSMCs采用细胞计数试剂盒(CCK-8)法和划痕法检测VSMCs的增殖和迁移能力。采用SPSS 22.0软件进行 χ2检验或 t检验。 结果:曲张组静脉管腔扩张，管壁增厚，细胞排列紊乱。与对照组比较，曲张组c-fos和骨桥蛋白(OPN)的mRNA水平明显升高( t＝4.872、6.221， P<0.05)，且c-fos表达与OPN/α-平滑肌肌动蛋白(α-SMΑ)呈正相关( R2＝0.509， P<0.01)。来自曲张组的VSMCs增殖(0.851±0.048比1.493±0.064， t＝13.990， P<0.05)和迁移(0.403±0.032比0.708±0.033， t＝9.335， P<0.05)能力显著增强。此外，曲张组VSMCs的c-fos蛋白表达显著上调( t＝17.270， P<0.05)，伴随着α-SMA的降低( t＝3.329， P<0.05)和OPN的增加( t＝5.990， P<0.05)。 结论:病变标本中c-fos的表达水平上调，同时表型标志物(OPN/α-SMA)也发生改变。曲张组原代培养的VSMCs具有增强的增殖和迁移能力。c-fos的上调可能在VSMCs表型转换中起作用，进而参与静脉曲张的发病机制。

abstractsObjective:To investigate the histological and cytological changes in varicose veins (VVs).Methods:Patients with VVs and patients undergoing coronary artery bypass were enrolled. Real-time quantitative polymerase chain reaction and immunohistochemistry were used to assess the mRNA and protein expression of c-fos, α-smooth muscle actin (α-SMA) and osteopontin (OPN). Primary VSMCs were isolated from both groups and cultured in vitro. SPSS 22.0 software was used to perform statistical analysis with the χ2 test or Student’s t-test. Results:Significantly elevated mRNA levels of c-fos and osteopontin (OPN) were observed in the VV group ( t=4.872, 6.221, P<0.05), and a positive correlation was further demonstrated between the mRNA levels of c-fos and those of OPN/α-SMA ( R2=0.509, P<0.01). The VSMCs derived from the VV group were more numerous and had a significantly higher migration speed ( t=9.335, P<0.05). Moreover, the protein expression of c-fos was significantly upregulated in VSMCs derived from the VV group ( t=17.270, P<0.05), and this change was accompanied by a decrease in α-SMA ( t=3.329, P<0.05) and an increase in OPN ( t=5.990, P<0.05). Conclusion:C-fos upregulation might play a role in the phenotypic switching of VSMCs and subsequently participate in the pathogenesis of VVs.