心脏移植术后心内膜心肌活检的病理观察  

The clinicopathological endomyocardial biopsy analysis in cardiac transplant recipients due to end- stage heart failure

作　　者：李莉[1] 赵红[1] 王红月[1] 吕凤英[1] 刘蕾[1] 王清峙[1] 司文学[1] 

机构地区：[1]中国医学科学院

出　　处：《中华心血管病杂志》2006年第9期819-821,共3页Chinese Journal of Cardiology

摘　　要：目的分析我院42例终末期心力衰竭患者心脏移植术后心内膜心肌活检的病理改变,为术后治疗及疗效评价提供形态学依据。方法心脏移植受者42例(男35例,女7例)进行了72次心内膜心肌活检(endomyocardial biopsy,EMB),所取右室室间隔心肌组织按常规固定、脱水、包埋、石蜡切片,苏木素-伊红(HE)和磷钨酸苏木素(PTAH)染色。光镜观察,按照2004年国际心肺移植协会(ISHLT)重新修定的 EMB 急性细胞性排异反应的标准进行分级。结果术后发生急性细胞性排异反应36次,其中1 R 级(也称轻度排异,包括1990年标准的Ⅰa、Ⅰb和Ⅱ级)32次,2 R 级(也称中度排异,即1990年标准的Ⅲa级)4次;心肌缺血性损伤、坏死4次;Quilty 病变1次;未见缺血性坏死及排异反应31次。结论 EMB 是评价心脏移植术后排异反应的“金标准”,可指导临床治疗并对疗效进行评价。本组病例供体心脏发生细胞性排异反应的频率较低,程度较轻。移植术后死亡率低,与发达国家水平接近。移植术后1个月内供体心脏发生急性细胞性排异的比例较低,而且均为轻度排异。1～6个月期间,急性细胞性排异的发生率明显上升,但仍以轻度排异为主。6个月后,急性细胞性排异反应仍然存在。本组病例中心肌缺血性损伤虽然存在,但并不像文献报道的那么普遍。Objective Endomyocardial biopsies from 42 （35 males and 7 females, aged 43.3 years） heart transplant recipients due to end-stage heart failure between June 2004 and January 2006 in our institute were obtained for pathological studies. Methods Sixteen patients underwent 1 endomyocardial biopsy （right ventricular septum） between 13 days to 5 months, 13 patients underwent second biopsy between 1.5 to 8 months and 10 patients underwent third biopsy between 3 to 8. 5 months post transplantation. Specimen were stained by hematoxylin-eosin （HE） and Phosphotungstic Acid Hematoxylin （PTAH） and observed under light microscope and cardiac allograft rejection were evaluated according to the Revision of the 1990 working formulation for the standardization of nomenclature in the diagnosis of heart rejection in 2004. Results The rejection grades were as follows： Grade 0 R in 31 biopsies; Grade 1 R （ mild rejection 1990 grade 1 A, 1B and 2. ） in 30 biopsies ; Grade 2 R （ moderate rejection, 1990 grade 3 A） in 3 biopsies; Grade 1 R cellular rejection companied with humoral rejection in 1 biopsy. Cellular rejection with Quihy effect was found in 2 biopsies. Ischemic myocardial injury presented in 4 biopsies. Quihy effect was observed in 1 biopsy. Cytomegalovirus or toxoplasmic myocarditis was not observed. Conclusions Endomyocardial biopsy （EMB） is a valuable diagnostic procedure for rejection surveillance in heart allograft recipients. The observed low rejection incidence and mild rejection from specimens of our heart recipients were comparable to the results of developed countries.

关 键 词：心脏移植 活组织检查 心肌 病理学 临床 

分 类 号：R654.2[医药卫生—外科学]