心肌扩张型心脏病的病理形态特征及其临床意义  

Cfinicopathologic analysis of dilated heart in cardiac transplant recipients

作　　者：吕凤英[1] 宋来凤[1] 刘蕾[1] 赵红[1] 王红月[1] 李莉[1] 王琳琳[1] 王清峙[1] 司文学[1] 张连庄[1] 李晓惠[1] 赵然旭[1] 

机构地区：[1]中国医学科学院 北京协和医学院 阜外心血管病医院病理科,100037

出　　处：《中华病理学杂志》2007年第12期796-800,共5页Chinese Journal of Pathology

摘　　要：目的探讨单纯心壁病损造成的心脏扩张者的病理形态特征及其意义。方法收集2004年6月至2006年8月中国医学科学院北京协和医学院阜外心血管病医院60例心脏移植的受体心脏在离体后立即进行了肉眼观察、测量和摄影记录,并进行了全面的组织病理学观察。以其中40例单纯心壁病损造成的心脏扩张者进行临床-病理对照分析,并观察其形态特点。结果 40例单纯心壁病损造成的心脏扩张者中21例(52.5%)为原发性扩张型心肌病,9例(22.5%)为致心律失常性右心室心肌病,6例(15.0%)为缺血性心肌病,其余的4例(10.0%)为局灶性心肌致密化不全、巨细胞性心肌炎和特异性心肌病中的酒精性心肌病和高血压性心肌病。40例中临床诊断与病理诊断不符15例(37.5%),不相符率较高的依次为致心律失常性右心室心肌病(7/9)、缺血性心肌病(5/6)和巨细胞性心肌炎(1/1)。不相符的这几种病的原临床和影像学诊断都是扩张型心肌病。致心律失常性右心室心肌病、缺血性心肌病、心肌致密化不全和巨细胞性心肌炎都有特征性的病理形态表现,酒精性心肌病和高血压性心肌病等的病理诊断需要参考临床病史。该组病例没有观察到慢性心肌炎样病变发展成扩张型心肌病的形态学迹象。结论进行心脏移植病例受体心脏的病理学检查有利于提高心脏病的临床和影像诊断的正确率,病理形态检查是不可忽视的重要手段。Objective To study the pathologic features of dilated heart in cardiac transplant recipients, with clinicoradiologic correlation. Methods Sixty recipient hearts from cardiac transplantation performed in Fuwai Hospital were analyzed by gross examination, histologic observation and electron microscopy. Clinicoradiologic correlation was available in 40 cases. Results Amongst the 40 cases of dilated heart, 52. 5% （21/40） were due to dilated cardiomyopathy, 22. 5% （9/40） due to arrhythmogenic right ventricular cardiomyopathy, 15.0% （6/40） due to ischemic cardiomyopathy, and the remaining 10, 0% （4/40） due to miscellaneous causes, including local noncompaction of ventricular myocardium, giant cell myocarditis, alcoholic cardiomyopathy and hypertensive cardiomyopathy, The discrepancy rate between clinical and pathologic diagnosis was 37.5% （15/40）. The erroneous categories included arrhythmogenic right ventricular cardiomyopathy （7 cases）, ischemic cardiomyopathy （5 cases）, and giant cell myocarditis （1 case）, which were all mistaken clinically as dilated cardiomyopathy, While ischemic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, noncompaction of ventricular myocardium and giant cell myocarditis have distinctive pathologic features, the diagnosis of alcoholic and hypertensive cardiomyopathies required clinicopathologic correlation. Dilated cardiomyopathy due to viral myocarditis was not identified in the cases studied. Conclusion Pathologic examination is essential in analysis of transplant recipient heart and helps to rectify clinical diagnostic discrepancy.

关 键 词：心脏病 心脏扩大 病理学 临床 

分 类 号：R542.2[医药卫生—心血管疾病]