风湿性心脏病继发肺高压的肺肌型动脉病理特点  

The pathological characteristics of pulmonary muscular artery in the secondary pulmonary hypertension of rheumatic heart disease

作　　者：刘鲁祁[1] 王春祥[1] 吴彩志[1] 邵伟[1] 李培杰[1] 

机构地区：[1]山东省千佛山医院心脏外科,济南250014

出　　处：《临床心血管病杂志》2001年第7期304-305,共2页Journal of Clinical Cardiology

摘　　要：目的 :揭示风湿性心脏病合并肺动脉高压时肺肌型动脉病变特征。方法 :选择自 1997～ 2 0 0 0年 17例风湿性心脏瓣膜病合并肺动脉高压患者行病理分析 ,所有患者均于术中测主肺动脉压 ( PPA )和升主动脉压( PA) ,计算 PPA/PA比值 ,作为评价肺动脉高压的标准之一。测量肺活检标本中肌型动脉外径 ( D)和中层 ( M)、内膜 ( I)厚度 ,计算 M/D、I/D比值 ,作为评价肺血管改变的指标。用统计学方法对以上各参数进行比较。结果 :肺动脉高压组 M/D值与 I/D值增高 ,与正常对照组比较差异有显著性意义。结论 :肌型动脉壁肥厚、胶原和弹力纤维组织增生、小动脉肌型化是被动性肺动脉高压的主要病理改变之一。Objective: To demonstrate the pathological characteristics of changes of pulmonary muscular arteries in rheumatic heart disease (RHD) with severe pulmonary hypertension. Method: Seventeen RHD patients with pulmonary hypertension were selected from 1997 to 2000 for pathological and clinical analysis. The pressure of pulmonary artery (PPA) and aortic artery (PA) were measured during the heart surgery and PPA/PA ratio calculated as an estimated standard of pulmonary hypertension. Ten other patients with lung cancer were selected as control group and their normal lung tissues were selected for pathological analysis. The vessel diameter (D) and the thickness of medium layer (M) and inner membrane (I) of all pulmonary muscular arteries were measured in detail based on the lung biopsy specimen. M/D and I/D were calculated as an estimated standard of thickening of the vessel wall. Result: Comparison among M/D, I/D and PPA/PA were made by statistical analysis including t′test and correlation analysis. The results demonstrate that there was remarkable difference in M/D between two groups. There was close positive correlation between PPA/PA and M/D. Conclusion: The wall thickening of muscular arteries, hyperplasia of the collagen and elastic fibrous tissue, and muscularization of small arteries are the predominant pathologic lesions in passive pulmonary hypertension.

关 键 词：风湿性心脏病 肺性高血压 肌型动脉 病理学 肺动脉高压 

分 类 号：R541.2[医药卫生—心血管疾病] R543.2[医药卫生—内科学]