高齢者剖検例における動脈硬化退縮の検討(3) : 陥凹性病変と動脈硬化危険因子 Atherosclerosis Regression in The Elderly-Correlation Between Centrally Depressed Lesions and Risk Factors
高齢者大動脈における, 中心に陥凹を有する非潰瘍性動脈硬化性病変 (陥凹性病変) の存在に注目し, この陥凹性病変が動脈硬化退縮の一形態の可能性があることを報告してきた. 今回, この陥凹性病変の形態発生を明らかにするため動脈硬化の危険因子であるコレステロールなどを病歴より検索し, 陥凹性病変の関連について検索した.<br>陥凹性病変は動脈硬化症の高度群に多くみられ, コレステロール低値群ならびに高値群にもみられたが, 低値群に多かった. ほとんどの症例において入院前に比べて入院中のコレステロール値が減少していた. 進行性の動脈硬化巣にあっても陥凹性病変に移行する可能性があり, 早期に治療を行えば動脈硬化に基づく様々な病態や続発症を阻止できることが示唆された.
Atherosclerotic plaque with central depression (depressed lesion) may indicate regression of atherosclerosis in the aorta. Aortic depressed lesions have a solitary elevated area of plaque with a sharply-bordered roung depression in its center and no area ulceration. This may be interpretable as a sign of regression of atherosclerosis. To clarify the pathogenesis of depressed lesiosn, we studied clinical risk factors such as hypercholesterolemia in patients with depressed lesions that were confirmed at autopsy. The patients were divided into 3 groups according to their total cholesterol level at autopsy: a high-risk group (≥220mg/dl), a moderate-risk group (180-220mg/dl), and a low-risk group (≤180mg/dl). Depressed lesions were found in 16.4% of those in the high-risk group, in 14.6% of those in the moderate-risk group and in 69.0% of those in the low-risk group. Severe aortic atherosclerosis was found in 69.8% of the patients; 50.9% of those with severe disease were in the-low risk group. Depressed lesions were also found in those with low levels of low-density lipoprotein cholesterol (≤140mg/dl), 58.8% of whom were found to have severe atherosclerosis. There was no relationship between total cholesterol level and the presence of depressed lesions. However, a clinical prevention trial may result in sufficient control of ahterosclerosis among those in the high-risk group and may also lead to regression of aortic lesions.
日本老年医学会雑誌 33(12), 923-927, 1996-12-25
The Japan Geriatrics Society