心房颤动对风湿性心脏病患者左右心房肌细胞形态结构的影响  

Morphological changes of left and right atrial myocytes in rheumatic heart disease patients with atrial fibrillation

作　　者：黄骥[1] 宋治远[1] 仝识非[1] 

机构地区：[1]第三军医大学西南医院心血管内科,重庆市介入心脏病学研究所,重庆400038

出　　处：《第三军医大学学报》2005年第1期67-69,共3页Journal of Third Military Medical University

基　　金：第三军医大学科研基金资助项目 ( 2 0 0 1)~~

摘　　要：目的　研究心房颤动 (房颤 )对风湿性心脏病 (风心病 )二尖瓣病变患者左、右心房肌细胞形态结构的影响。方法　 3 1例风心病换瓣患者分为 3组 :①实验Ⅰ组 (11例 )为阵发性房颤或房颤持续时间≤ 6个月 ;②实验Ⅱ组 (12例 )为房颤持续时间均 >6个月 ;③对照组 (8例 )为窦性心律。行光镜和透射电镜检查。结果　①对照组、实验Ⅰ组及实验Ⅱ组Aschoff小体阳性率分别为 3 7 5 % (3 / 8)、46% (5 / 11)及 5 0 % (6/ 12 ) ,并且左、右心房肌改变一致。②细胞变性、间质增生、淋巴细胞浸润及血管反应在 3组内左、右心房肌或组间亦改变一致。③ 3组患者左、右心房肌均有不同程度的肌丝溶解、糖原聚集及间质纤维化 ,但实验组较对照组有加重。结论　风心病患者左、右心房肌病理形态学改变基本一致 ;心房肌的纤维化与房颤的发生及维持有关。Objective To investigate the effects of atrial fibrillation (AF) on the morphological changes of left and right atrial myocytes in patients with rhematic heart disease. Methods A total of 31 patients undergoing cardiac surgery for correction of valvular defect were divided into three groups: Group Ⅰ (n=11), AF lasted ≤6 months; Group Ⅱ (n=12), AF lasted>6 months; Control group (n=8) without AF. Atrial muscle samples of the left and right atrial appendage were cut off during heart valve replacement. Morphological changes were observed by light microscopy and electron microscopy. Results ① The incidence rates of Aschoff body were 37.5% (3/8), 46% (5/11) , and 50% (6/12) in Group Ⅰ, Group Ⅱ, and the control group. There was no difference in Aschoff body between the left and right atrial myocytes. ② There was no difference in myocytic degeneration, interstitial hyperplasia, and lymphocytes infiltration between the left and right atrial myocytes in each group. ③ Myolysis, accumulation of glycogen, and fibrosis were detected by electron microscopy in the 3 groups. Changes of myolysis and fibrosis were more obvious in patients with AF than patients without AF. Conclusion There are similar pathological changes in the left and right atria in rheumatic heart disease patients with or without AF. Fibrosis of atrial myocytes may be involved in the occurrence and maintenance of AF.

关 键 词：风湿性心脏病 心房颤动 心房肌病理 

分 类 号：R329.24[医药卫生—人体解剖和组织胚胎学] R541.2[医药卫生—基础医学]