风湿性瓣膜病心肌损害的体视学分析  

Stereological studies of myocardium in different types of rheumatic vavular diseases

作　　者：苏丕雄[1] 官颖鹏[2] 尤斌[3] 王盛宇[3] 陈英淳[3] 

机构地区：[1]北京红十字朝阳医院心脏中心心外科,100020 [2]北京海军总医院病理科 [3]北京安贞医院心外科,100029

出　　处：《中华胸心血管外科杂志》2000年第6期324-326,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的　用体视学方法较准确揭示风湿性瓣膜病不同类型的心肌病理损害特点。方法　通过光镜、电镜及电子计算机图像分析系统 ,用体视学方法 ,对 2 9例不同类型风湿性瓣膜病瓣膜置换病人(RHD组 )及 7例急性非心血管病死亡者 (对照者 )心肌的心肌细胞、间质纤维化、肌原纤维及线粒体含量进行定量分析。RHD组分二尖瓣狭窄 (MS)组 (12例 ) ,二尖瓣关闭不全 (MR)组 (7例 ) ,主动脉瓣关闭不全 (AR)组 (6例 )和双瓣膜置换 (DVR)组 4例。用超声心动图测定换瓣前左室功能及左室心肌重量指数。结果　间质纤维化含量 (F % ) :RHD各组间无差别 ,但明显高于对照组。心肌细胞胞密度 (Vc % ) :MR及AR组明显低于对照组及MS组 ,AR及MR组间无差别。肌原纤维体密度 (Vvmyo % ) :RHD各组明显低于对照组。组间AR组低于MS组。线粒体体密度 (Vvmit% ) :MS组与对照组无显著差异 ,MR及AR组低于对照组及MS组。线粒体比膜面 (δmmit% ) :RHD各组比膜面明显低于对照组 ,各组间无显著差异。线粒体面数密度 (NA% ) :MR及AR组低于对照组及MS组 ,MR组与AR组间无显著差异。线粒体比表面(δmit% )、线粒体平均截面 (Amit% ) :各组间均无显著差异。DVR组 4例左室流出道与二尖瓣乳头肌体视学结果无差异。结论　风湿性瓣膜病病人术前均有较明显?Objective A stereological study of the pathological changes of myocardium in rheumatic valve disease.Method Twenty nine patients with valvular disease were investigated. They were divided into three groups according to the surgical procedures: MS group(n=12), MR group(n=7),AR group (n=6), and DVR group (n=4). 8 patients with non heart disease as control group. Structure of left ventricular muscle were investigated morphometrically by both light and eletronic microscopy. Result F% was significantly higher in RHD group than that in control group. There were no differences among MS,MR. and AR groups. Vc% in MR and AR groups were significantly lower than that in control group and MS groups. There were no differences between MR and AR groups. Vvmyo% was significantly lower in RHD group than that in control group. AR group was also lower than that MS group. Vvmit% was lower in MR and AR groups than in control and MS groups. δmmit was significantly lower in RHD group than that in control group. There were no differences among MS, MR and AR groups. N A was lower in MR and AR groups than that in control and MS groups. MR group was as same as AR group. The morphological results of left ventricular papillary muscle and left ventricular outlet myocardium had no differences. Conclusion All patients with rheumatic heart valve disease have different degree of pathological damages of myocardium. The myocardial damage is more severe in AR and MS groups than that in MS group. The pathological damage of myocardium is the important cause of the higher perioperative mortality and the poor prognosis in some patients after cardiac valve replacement.

关 键 词：风湿性瓣膜病 心肌 体视学 

分 类 号：R541.3[医药卫生—心血管疾病]