心肌纤维化患者血清细胞外基质的变化及其临床意义  

Changes and clinical significance of serum extracellular matrix turnover with myocardial fibrosis

作　　者：武利军[1] 赵连友[1] 郑强荪[1] 徐焰[2] 马福臣[3] 

机构地区：[1]第四军医大学唐都医院心内科,西安710038 [2]第四军医大学西京医院检验科 [3]第四军医大学西京医院病理科

出　　处：《临床心血管病杂志》2006年第1期18-20,共3页Journal of Clinical Cardiology

摘　　要：目的:观察3种不同病因[风湿性心脏病(RHD)、扩张型心肌病(DCM)、先天性心脏病(congenitalheardisease,CHD)]的心肌纤维化患者血清细胞外基质(ECM)含量的变化,评价其临床价值。方法:选取20例RHD、7例DCM患者左室心肌及20例CHD患者右室心肌标本进行心肌间质Ⅰ、Ⅲ型胶原天狼猩红染色,5例正常心肌标本作对照。图像分析系统检测心肌纤维化面积,计算胶原容积分数(CVF);放射免疫法测定心肌纤维化患者与健康对照组(20例)血清ECM[含Ⅰ型前胶原(PCⅠ)、Ⅲ型前胶原(PCⅢ)、黏连蛋白(LN)]含量,并与CVF、心功能作相关性分析。结果:①RHD、DCM、CHD患者心肌间质纤维化面积分别为21.47±6.32、18.62±2.24、12.43±3.16,与健康对照组(5.47±1.68)比较,差异有统计学意义(P<0.01);②心肌纤维化组RHD、DCM、CHD患者血清中PCⅠ、PCⅢ、LN含量均较健康对照组明显增高,差异均有统计学意义(P<0.05或P<0.01);③心肌纤维化组血清ECM水平与心肌纤维化面积及心功能分级呈正相关。结论:心肌纤维化患者血清ECM成分能够反映胶原增生代谢状况,可作为评价心肌纤维化的临床指标。Objective：To investigate the changes and their clinical significance of serum extracellular matrix turnover with three etiopathogenesis inducing myocardial fibrosis. Method：Collagen types Ⅰ and Ⅲ in myocardium specimens of 20 patients with rheumatic heart disease（RHD）,7 patients with dilated cardiomyopathy（DCM）, 10 patients with congenital heart disease（CHD） and 5 healthy adults were observed by Sirius Red F3B（SR） staining. The area of myocardial fibrosis was measured by imaging analysis system; The serum content of procollagen Ⅰ （PC Ⅰ ）, p roeollagen Ⅲ （PC Ⅲ）, laminin（LN） were measured by radioimmunoassay with all patients and 20 normal serum samples composing the control groups individually. Result： ①The collagen volume fraction （CVF） in RHD（ 21.47±6.32）, DCM（18.62±2.24） and RHD（12. 43±3.16） patient groups were significantly higher than that of normal control group（5.47± 1.68） （ P 〈0.01）. ②The contents of serum ECM（μg/L） in RHD group （PCⅠ,73.24±21.48, PCⅢ： 136.43±36.26, LN：124. 67 ±16. 65, DCM group（PCⅠ= 60.86±18.58, PC Ⅲ： 128.42±40.24, LN,108.66±15.31）and CHD group（PC Ⅰ ： 56.32±13.84, PCⅢ ： 98.40±20. 44,LN：94. 62±15.36）were significantly higher than those in control group（PC Ⅰ ：48.18± 14.34,PCⅢ ：70.28±14.34,LN：82.54 ± 13.40）respectively （ p 〈0.05）. Meanwhile, the serum content of ECM were correlated positively with the area of myocardial fibrosis and the NYHA cardiac function class. Conclusion. It is suggested that the level of serum ECM might be used to evaluate the degree and prognosis of cardiac fibrosis in patients with RHD, DCM and RHD.

关 键 词：心肌纤维化 胶原 细胞外基质 

分 类 号：R542.1[医药卫生—心血管疾病]