射血分数降低的心力衰竭患者心内膜心肌活检及超微结构特征分析  

Endocardial myocardial biopsy and ultrastructural characteristics in heart failure patients with reduced ejection fraction

作　　者：王家琪 陈东[1] 郑梦晗 方微[1] 商建峰[1] 周皓锬 连国亮[1] 梅少帅[1] Wang Jiaqi;Chen Dong;Zheng Menghan;Fang Wei;Shang Jianfeng;Zhou Haotan;Lian Guoliang;Mei Shaoshuai(Department of Pathology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院病理科,北京100029

出　　处：《中华病理学杂志》2025年第3期259-265,共7页Chinese Journal of Pathology

基　　金：北京市医院管理中心创新梦工场经费资助(202114)。

摘　　要：目的探讨射血分数降低的心力衰竭患者的心内膜心肌活检及超微结构特征,以确定组织病理表型,探究心内膜心肌活检对此类患者的诊断价值。方法收集2022年1月至2023年12月期间首都医科大学附属北京安贞医院诊断的射血分数降低的心力衰竭患者行心内膜心肌活检者共35例,分析临床特征、组织病理学及超微结构特征,与11例射血分数保留的心力衰竭患者进行比较。结果35例患者男性26例,女性9例;年龄35~58岁,中位年龄为51岁。心肌纤维化和心肌纤维紊乱为最常见的组织病理学改变[分别为97.1%(34/35)和74.3%(26/35)]。心肌纤维化在射血分数降低的心力衰竭组与射血分数保留的心力衰竭组差异无统计学意义[13.3%(5.7%~21.4%)比13.2%(9.3%~34.2%),P=0.279]。最显著的超微结构改变是线粒体密集增生、空泡变性,心肌纤维排列紊乱,局部溶解、断裂。经心内膜心肌活检有11例(11/35,31.4%)患者明确了病因,其中心脏淀粉样变性占比为17.1%(6/35)。结论以射血分数降低的心力衰竭为主要表现的患者,心内膜心肌活检有助于早期诊断和精准治疗。组织病理学及超微结构分析可以通过提供相关的发病机制信息和临床演变,从而挖掘潜在治疗手段并预测、改善患者预后。Objective To investigate the endocardial myocardial biopsy and ultrastructural features of heart failure patients with reduced ejection fraction,to determine their histopathologic phenotype,and to explore the diagnostic utility of endomyocardial biopsy in such patients.Methods A total of 35 patients with heart failure with reduced ejection fraction diagnosed at Beijing Anzhen Hospital and underwent endomyocardial biopsy were collected between January 2022 and December 2023.The clinical features,histopathological,and ultrastructural characteristics were analyzed and compared with 11 patients with heart failure with preserved ejection fraction.Results The age ranged from 35-58 years,with median age of 51 years;there were 26 males and 9 females.Myocardial fibrosis and myocardial fiber disorders were the most common histopathologic changes[97.1%(34/35)and 74.3%(26/35),respectively].Myocardial fibrosis was not statistically different between the heart failure with reduced ejection fraction group and the heart failure with preserved ejection fraction group[13.3%(5.7%-21.4%)vs.13.2%(9.3%-34.2%),P=0.279].Significant ultrastructural changes were dense mitochondrial proliferation,vacuolar degeneration,and disorganized arrangement of myocardial fibers with localized lysis and fracture.After endomyocardial biopsy,the etiology was identified in 11 patients(31.4%,11/35),with a prevalence of cardiac amyloidosis of 17.1%(6/35).Conclusions Endomyocardial biopsy is useful for early diagnosis and precise treatment in patients presenting with heart failure with reduced ejection fraction.Histopathological and ultrastructural analyses can uncover potential treatments,and predict and improve prognosis by providing relevant information for understanding the pathogenesis and clinical evolution.

关 键 词：心力衰竭 心内膜 活组织检查 心内膜心肌纤维化症 显微镜检查 电子 射血分数 

分 类 号：R54[医药卫生—心血管疾病]