中文摘要：

目的 探讨人颅内动脉粥样硬化的程度和分布以及炎性因素的作用。方法以33例患者尸检脑血管为研究对象，10％甲醛固定后检测动脉粥样硬化在Willlis环不同部位的分布，组织学和免疫组化法检测管壁结构、CD68阳性的炎细胞和肿瘤坏死因子a的变化。结果 年龄高、高血压病程长者颅内动脉粥样硬化程度重，复合型斑块明显增多。颅内动脉粥样硬化分布依次为基底动脉71％～72％、大脑中动脉67％～70％、椎动脉59％～69％、大脑后动脉40％～54％、大脑前动脉41％～43％。固定后人颅内动脉外径／内径的平均值为基底动脉0．400cm／0．200cm，大脑中动脉0．326cm／0．195cm，椎动脉0．356cm／0．186cm，大脑后动脉0．243cm／0．140cm，大脑前动脉0．226cm／0．120cm。动脉壁最厚处可为0．500cm。粥样硬化斑块可以闭塞管腔，也可以向管壁外增生而管腔无狭窄。动脉粥样硬化多数发生自内膜下，也可以始于肌层和外膜。CD68阳性的炎细胞多数分布在正常管壁与异常管壁交界的部位，也可分布在内膜下或斑块内。肿瘤坏死因子与炎细胞分布不同步：多数分布在整个粥样斑块中，也见于细胞结构正常的动脉内膜下。没有常规危险因素的年轻人有严重的动脉粥样硬化并有大量的炎性因子的表达。巨细胞病毒染色全部阴性。光镜内膜结构正常的管壁上可见血栓形成。结论 人颅内动脉中基底动脉和大脑中动脉的动脉粥样硬化程度最重。炎性因素参与了动脉粥样硬化的形成和加重。

英文摘要：

Objective To observe the distribution of arteriosclerosis and the inflammatory factors in intracranial artery, and to discuss the role of inflammation in the genesis of atherosclerosis. Method The arteriosclerosis degree was measured, and the CD68 positive cells, antigen of cytomegalovirus and TNFα expression were determined in 33 cases of autopsied intracranial artery. Results The complex plaque of arthrosclerosis was much more in number in those with older age and a longer hypertension history. The severe arthrosclerosis was mainly distributed on basal artery 71%—72%, middle cerebral artery 67%— 70% , vertebra artery 59%—69% , cerebral posterio artery 40%—54% , cerebral anterior-artery 41%— 43%. The average fixed artery diameter of out/inner was 0. 400 cm/0. 200 cm for basal artery, 0. 326 cm/ 0. 195 cm for middle cerebral artery,0. 356 cm/0. 186 cm for vertebral artery, 0. 243 cm/0. 140 cm for cerebral posterio artery, 0. 226 cm /0. 120 cm for anterior artery. The thickest wall was 0. 500 cm. Arthrosclerosis either occluded the vessel cavity or generate outward without occupying the normal cavity. The arthrosclerosis of intracranial artery began from internal membrane, some of them with normal appearance of intimal layer, though, had severe outer membrane lesion. CD 68 positive cells distributed in different ways, most of them at the boundary of normal and abnormal artery, some in the intimal layer, and some scattering in the plaque. The distribution of TNFα, differently from CD68, were spotted in the abnormal area. Especially, positive CD68 cells and TNFα expression were found in the intimal layer with normal appearance without artery wall changing. The antigen of cytomegalovirus examined in 12 cases by immunohistochemistry were all negative. The Wilson＇ s patient, without any other risk factor of cerebral vascular disease, had severe and extensive arthrosclerosis and positive CD68 and TNFα expression. Conclusions The most severe arthrosclerosis occurs in basal artery and cerebral middle arter