婴幼儿肺动脉闭锁合并室间隔缺损的肺组织形态学改变  

The pathological changes of lung in infants with pulmonary atresia with ventricular septal defect with or without aortopulmonary collateral arteries

作　　者：张晓彤[1] 刘迎龙[1] 阮英茆[2] 于存涛[1] 刘蕾[2] 

机构地区：[1]中国医学科学院心血管病研究所阜外心血管病医院小儿心脏中心,北京100037 [2]中国医学科学院心血管病研究所阜外心血管病医院病理科,北京100037

出　　处：《中华胸心血管外科杂志》2007年第6期389-392,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：本课题受“十五”国家科技攻关计划（2002BA709B09）资助

摘　　要：目的观察婴幼儿肺动脉闭锁的肺组织形态学改变，了解体循环血流对肺组织发育的影响。方法2000年1月至2003年12月有肺组织病理切片资料的22例肺动脉闭锁合并室间隔缺损（PA-VSD）病儿作为病变组，4～36月龄。全部病例左、右肺动脉有融合，1例同时合并动脉导管未闭（PDA）和体-肺动脉侧支，3例合并体-肺动脉侧支，其余病例合并PDA。5例4～18月龄非心、肺源性疾病死亡的婴幼儿作为对照组。形态半定量测量肺细小动脉平均中膜厚度百分比（MT%）和中膜面积百分比（MS%），单位面积肺细小动脉数目（APSC），单位面积肺泡数（MAN），平均肺泡内衬间隔（MLI），肺实质占同切片肺总面积比例（PPA%）和单位面积肺泡数/肺细小动脉数比（AAR）。结果病变组肺泡的内径增大，单位面积肺泡数目减少，肺实质占同切片肺总面积比例减少，差异有统计学意义（P〈0.05）。病变组肺细小动脉内、外弹力板间距以及MT%和MS%与对照组之间差异无统计学意义（P〉0.05）。病变组血管MT%从6.43%～25.85%，MS%从15.45%～39.79%。2例有较大的体-肺动脉侧支供血的病婴由于局部肺血增多导致中膜增厚。病变组的APSC低于对照组，AAR高于对照组，P〈0.05。结论肺循环血量明显影响肺细小动脉的增殖程度；动脉导管和（或）体-肺动脉侧支为肺循环提供的血流远不能满足外周肺血管的发育；体-肺动脉侧支不仅未能增加肺的血供，反而可能使外周肺血管出现萎缩。肺循环血流减少对肺细小动脉发育的影响大于对肺泡发育的影响。Objective In order to find out the morphological features of small pulmonary arteries and alveoli in infants with pulmonary atresia with vehicular septal defect with or without aortopulmonary collateral arteries, several pathologic parameters were analyzed by contrast with infants died of non-cardiovascular diseases with normal pulmonary blood flow by morphologic quantitative analysis technique. Methods Autopsy specimens were obtained from 5 infants died of non-cardiovascular diseases as normal control group, 4 - 18 （9.80 ± 5.07） months. The pathological group＇s data were obtained from the pulmonary pathological slides, which were accumulated from 22 infants with pulmonary atresia with ventricular septal defect （PA-VSD） aged 4 - 36 （24.11 ± 6.07） months, between January 2000 and January 2004. The pulmonary blood supply was from PDA and/or aortopulmonary collateral arteries. All eases had confluent central pulmonary artery. The pulmonary blood supply was from PDA in 18 eases. Aortopulmonary collateral arteries in 2 eases were distributed to arteries anastomosised with central pulmonary artery at the hilum of the lung. Aortopulmonary collateral arteries of one patient directly went into fight upper lung, right lower lung and left upper lung. PDA and aortopulmonary collateral artery were concomitant in one autopsy case, there was no stricture between aortopulmonary collateral artery and pulmonary artery and the diameter of the aortopulmonary collateral artery was 8 mm. The tissue was fixed with buffered formlin, routinely prepared by impregnated in wax. Sections were stained by hematoxylin-eosin, Weigert＇ s elastic stain counter-stained by van Gieoson＇ s method. Seven parameters were obtained including percentage of media thickness （ % MT）, percentage of media section area （%MS）, numbers of small arterial per square centimeter （APSC）, mean alveolar number （MAN）, mean linear intercept （MLI）, proportion of psrenchyma area in total area （ohPPA） and alveolar/small arterial ra

关 键 词：肺动脉瓣闭锁 婴儿 室间隔缺损 组织学 

分 类 号：R686[医药卫生—骨科学]