The histologic appearance of atherosclerosis has been well described but its pathogenesis is still vigorously debated. The purpose of the present study is to clarify the stimuli for smooth muscle cells (SMC) migration and proliferation as well as the way of cholesterol crystals (CC) generation. We performed postmortem ultrastructural analysis of myocardial samples obtained from 45 patients (33 males, 12 females, age range 18-85) who died from different diseases, mainly from acute myocardial infarction-MI (37 cases). Tissue was taken by transthorax express-necropsy method immediately after patients' death in the clinic. In myocardial infarction cases intact zones of the heart were examined. We have found a few foci of modified SMC proliferation in the periarteriolar space around necrotic cellular debris in elder patients. Lymphocytes, myofibroblasts and some leukocytes infiltrated those areas. The modified SMC phagocyted necrotic material and formed secondary lysosomes, inside which from one to three CC originated. In parallel with the reduction of necrotic mass inside the lysosomes, CC size increased. In the final phase the CC were discharged from the SMC into the interstitium. After exocytosis a tendency for the CC to accumulate was observed. They formed clusters consisting of 20-30 crystals. Most of the CC were of typical needle-like or rhomboid shape. Modified SMC were producing not only CC but also collagen and elastin. This study indicates that atherosclerotic process in the myocardium is connected with the appearance of modified SMC inside which CC are generated.

译文

动脉粥样硬化的组织学表现已得到很好的描述,但其发病机理仍在激烈辩论中。本研究的目的是阐明平滑肌细胞 (SMC) 迁移和增殖的刺激以及胆固醇晶体 (CC) 产生的方式。我们对45例死于不同疾病的患者 (男33例,女12例,年龄18-85岁) 的心肌样本进行了死后超微结构分析,这些患者主要死于急性心肌梗死 (MI) (37例)。患者在诊所死亡后,立即通过经胸快速尸检方法采集组织。在心肌梗塞病例中,检查了心脏的完整区域。我们在老年患者坏死细胞碎片周围的小动脉周围发现了一些SMC增殖的病灶。淋巴细胞、肌成纤维细胞和一些白细胞浸润这些区域。修饰的SMC吞噬了坏死物质,并形成了次级溶酶体,在其中产生了一到三个CC。与溶酶体内坏死质量减少同时,CC大小增加。在最后阶段,CC从SMC排放到间质中。胞吐后,观察到CC积累的趋势。他们形成了由20-30个晶体组成的簇。大多数CC为典型的针状或菱形形状。改性SMC不仅产生CC,还产生胶原蛋白和弹性蛋白。这项研究表明,心肌中的动脉粥样硬化过程与内部产生CC的改良SMC的出现有关。

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