糖尿病心肌病的组织病理学观察  

Pathologic study of diabetic cardiomyopathy

作　　者：刘冬戈[1] 乔旭柏[1] 杜俊[1] 杨重庆[1] 方芳[1] 马正中[1] 陈蔓丽[2] 钱贻简[2] 

机构地区：[1]卫生部北京医院病理科,100730 [2]卫生部北京医院内科,100730

出　　处：《中华病理学杂志》2007年第12期801-804,共4页Chinese Journal of Pathology

基　　金：中央保健科研基金(2001AOD1)

摘　　要：目的探讨糖尿病心肌病的病理形态学特点、诊断、鉴别诊断及其发生机制。方法对40例糖尿病及40例非糖尿病尸检心肌进行临床、组织形态学及测微观察。结果 40例糖尿病中36例(90.0%)有微小心肌细胞坏死,37例(92.5%)有微小心肌间纤维瘢痕灶形成;40例非糖尿病仅8例(20.0%)有微小心肌细胞坏死,9例(22.5%)有微小心肌间纤维瘢痕灶形成;二组相比较差异有统计学意义(P<0.01)。糖尿病组心肌间微小血管壁明显增厚[(20.6±4.2)μm],与对照组[(7.2±5.2)μm]比较差异有统计学意义(P<0.01)。糖尿病组心肌病变与非糖尿病组高血压性心肌病变相似。结论糖尿病心肌病的病理诊断应首先排除引起心肌病变的其他疾病,再根据有长期糖尿病病史及前述心肌的病理组织形态学特征进行诊断;糖尿病心肌细胞微小坏死可能和心肌间微小血管壁明显增厚、缺血、缺氧有关。Objective To study the histopathologic features, differential diagnosis and pathogenesis of diabetic cardiomyopathy. Methods The clinicopathologic features of 40 autopsy cases of diabetes mellitus were studied. The hearts from another 40 cases of non-diabetic elderly deceased were used for comparison. Results In the 40 cases of diabetes studied, 36 cases （ 90.0% ） showed microscopic myocardial cell death. Focal interstitial fibrosis was observed in 37 cases （92. 5% ）. On the other hand, similar myocardial cell death and patchy interstitial fibrosis was seen in 8 cases （20. 0% ） and 9 cases （22. 5% ） of non- diabetic hearts, respectively. The difference between the two groups was statistically significant （ P 〈 0. 01 ）. The mural thickness of intramyocardial blood vessels was significantly increased in diabetic group （20. 6 μm ±4. 2μm） than in non-diabetic group （7. 2 μm ±5.2 μm） ,P 〈0. 01. The myocardial changes in diabetic group however were similar to those in non-diabetic group with systemic hypertension. Conclusions Pathologic diagnosis of diabetic cardiomyopathy relies on detailed histologic examination of heart tissue and clinical correlation of a long history of diabetes mellitus. Exclusion of other possible etiologies is also essential. The myocardial cell death observed may be due to the ischemic effect induced by diabetic microangiopathy in cardiac muscle.

关 键 词：糖尿病 心肌疾病 病理学 临床 尸体解剖 

分 类 号：R587.2[医药卫生—内分泌]