急性冠症候群発症時の冠動脈血栓における Tissue FactorとPlasminogen Activator Inhibitor-1の発現についての病理組織学的検討

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Thrombus formation and growth after plaque disruption are affected by tissue factor (TF) and plasminogen activator inhibitor-1 (PAI-1) in acute coronary syndrome (ACS) . Recently, thrombus aspiration during emergency coronary angiography has allowed for histologic examination of thrombi and atheromas at the onset of ACS. To clarify the expression of TF and PAI-1 in the thrombus, we histopathologically examined samples aspirated during emergency coronary angiography from patients with ACS. One hundred seventy-eight patients with ACS were studied (147 men and 31 women: mean age, 65.6 years) . The area of whole thrombus, the area of white thrombus (platelets and fibrin), and the area of red thrombus (red blood cell and fibrin) were measured with an image analyzer after staining with hematoxylin and eosin, and phosphotungstic acid hematoxylin stain. Samples were then stained immunohistochemically with antibodies against TF and PAI-1. Immunostaining with antibodies against CD68, myeloperoxidase (MPO), and p-selectin was also performed. Mixed thrombi, composed of red and white thrombi, were observed in all 178 samples, and atheroma fragments were observed in 82 samples. In large thrombi (sample area<10 mm<SUP>2</SUP>), the red/white thrombus area ratio correlated significantly with the whole thrombus area (R=0.59, P<0.01) . In histopathological examination, TF was observed in macrophages, including foam cells, in atheroma fragments. In the thrombus, leukocyte infiltration was observed conspicuously in the boundary between white and red thrombi. TF and PAI-1 were observed on leukocytes with MPO and CD68 positive cells in the same area. Moreover, the percentage of TF and PAI-1 positive cells in the boundary between white and red thrombi significantly correlated to thrombus size. Growth of the thrombus is related to proliferation of red thrombus. TF and PAI-1 on leukocytes remote from atheroma fragments seem to participate in this process.
学校法人昭和大学・昭和医学会の論文

急性冠症候群発症時の冠動脈血栓における Tissue FactorとPlasminogen Activator Inhibitor-1の発現についての病理組織学的検討

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