成人房室交界区过渡细胞束形态学及连接蛋白43和40的表达  

Morphology and the expression of connexin 43 and 40 in bundles of transition cells in the adult atrioventricular junction

作　　者：宋慧芳[1] 吕华[1] 范益民[2] 夏仲年[1] 阎八一[1] 高雨仁[1] 杨桂姣[1] 

机构地区：[1]山西医科大学人体解剖学教研室,太原030001 [2]山西医科大学第一医院,太原030001

出　　处：《解剖学报》2011年第5期670-674,共5页Acta Anatomica Sinica

摘　　要：目的观察临床上心律失常常见发生部位及射频消融治疗靶点部位———房室交界区和邻近区域的形态学特点及连接蛋白(Cx)43和40的表达,为心律失常发生机制及可能的有效治疗部位提供形态学依据。方法 10例正常成人心脏,选取房室交界区及其邻近部位,常规石蜡包埋,HE、Masson染色,选定目标部位行Cx43、Cx40免疫组织化学染色,并进行图像及统计学分析。结果峡部、冠状窦口周围和远端、二尖瓣纤维环处及与右房瓣上肌环邻近的中心纤维体等处可见较多过渡细胞束走行,并从不同方向与房室结及结后延伸不同部位相连。过渡细胞组成、排布、心肌纤维走行和相互间的联系有别于普通工作心肌。Cx43、Cx40在过渡细胞束1～4及右房瓣上肌环中分布范围小但集中,而在左房近膜部处的过渡细胞中表达较多;峡部Cx43、Cx40表达较集中。结论房室交界区及其邻近区域存在双(多)径传导的形态学基础,且与目前常用的射频消融治疗心律失常靶点部位具有对应关系。Objective To observe the morphological feature and the expression of connexin（Cx） 43 and Cx40 in the common arrhythmogenesis and radiofrequency ablation（RFA） region, the atrioventricular junction and its surrounding area, in order to provide the morphological basis for understanding the mechanism of arrhythmogenesis and possible sites for therapy. Methods Ten fresh normal adult hearts were used in this study. The specimens containing the atrioventricular node（AVN） was harvested, embedded in paraffin and sectioned. The sections were stained with HE, Masson staining. Expression of Cx43 and Cx40 was examined by immunohistochemistry and image analysis. Results There were the bundles of transition cells at cavo-tricuspid isthmus, around the opening and distal end of coronary sinus, at the annulus fibrosus of bicuspid valve, and at the central fibrous body（CFB） near the annulus of right atrium upper-valve muscles. The bundles connected between the AVN and posterior node extension（PNE） in different directions. The transition ceils were different from ordinary cardial muscle cells in the cell component, assignment, course and association of fibers. The distribution of Cx43 and Cx40 in bundles1-4 of transition ceils and annulus of right atrium upper-vavle muscles was limited in a small area. Expression of Cx43 and 40 was widely present in the transition cells of left atrium close to the membranous part of interventrieular septum and extensively localized at cavo-trieuspid isthmus. Conclusion Dual atrioventricular（AV） nodal pathways（DAVNP） and multiple AV nodal pathways（TAVNP） are at and nearby the atrioventrieular junction. And they are coherent with the target spots using in radiofrequency ablation to treat arrhythmia, which may indicate a new potential radiofrequency ablation site where the bundles of transition cells can be observed.

关 键 词：房室交界区 过渡细胞 形态学 连接蛋白 MASSON染色 免疫组织化学 成人 

分 类 号：R322.1[医药卫生—人体解剖和组织胚胎学]