小儿先天性心脏病合并重度肺动脉高压的病理学研究  

Quantitative Analysis of Lung Biopsy Tissue in Congenital Heart Defects Associated with Severe Pulmonary Hypertension in Young Children

作　　者：杜茗[1] 刘迎龙[1] 阮英茆[1] 凌坚[1] 

机构地区：[1]中国医学科学院阜外心血管病医院,北京100037

出　　处：《黑龙江医学》2003年第6期404-407,共4页Heilongjiang Medical Journal

摘　　要：目的　以定量肺病理学的方法 ,研究小儿左向右分流型先天性心脏病合并重度肺动脉高压 (PH)的肺小动脉病变。方法　先天性心脏病合并重度PH左向右分流型患儿 38例为PH组 ,于术前右心导管检查 2 1例 ,手术中取肺活检 ;另取非心血管病死亡婴幼儿尸检肺组织 6例为无PH组。光镜观察肺内病变 ,并以显微 -微机彩色图像分析仪测量计算肺细小动脉平均中膜厚度百分比 (%MT)、肺细小动脉平均中膜面积百分比 (%MS)及肺小动脉密度 (APSC)。结果　PH组 %MS、%MT及APSC均较无PH组明显升高 ,吸氧后的肺动脉收缩压 (SPAPO2 )与 %MT和 %MS均呈直线相关 ,回归方程分别为 :%MS =0 0 690 9SPAPO2 + 4 5 95 64,(P <0 0 5 ) ,r =0 4 4 14;%MT =0 12 67SPAPO2 + 2 5 4 10 7,(P <0 0 5 ) ,r =0 4 4 74。结论　定量测量肺小动脉中膜厚度、面积及密度 ,可以判定左向右分流先天性心脏病PH的严重程度 。Objective To evaluate the method of quantitative analysis and investigate the changes of pulmonary arterioles in left to right shunt congenital heart defects associated with severe pulmonary hypertension (PH) in young children. Methods Lung biopsies were taken in the corrective operations in 38 young children suffered from left to right shunt congenital heart defects associated with severe PH. Autopsy specimens were obtained from 6 children died of non-cardiovascular diseases. All specimens were quantitative analyzed and the following parameters of pulmonary arterioles were calculated percentage media wall thickness (%MT), percentage media wall area (%MS) and arteriole density (arterioles per square centimeter, APSC). Results %MS, %MT and APSC were significantly increased in cases associated with PH. The systolic pulmonary arterial pressure during oxygen inhalation (SPAPO 2 ) correlated with %MT and %MS, %MS = 0.06909 SPAPO 2 +45.9564(P<0.05), r = 0.4414; %MT = 0.1267 SPAPO 2 +25.4107 (P<0.05), r=0.4474. Conclusion Quantitative analysis of pulmonary arterioles could determine the severity of PH caused by left to right shunt congenital heart defects. It was especially useful in the premature lung of infants and young children.

关 键 词：心血管外科学 心脏缺损 先天性 高血压 肺性 肺活检 

分 类 号：R654.2[医药卫生—外科学]