风心病房颤患者右房心肌细胞闰盘结构和心房颗粒病理变化的研究

Study on interdiac structure of right atrium myocardium in patients with rheumatic heart disease in sustained atrial fibrillation

目的探讨风心病持续性AF患者右房闰盘与心房颗粒病理变化。方法选择29例风湿性二尖瓣置换术患者,根据有无持续性心房颤动分为心房颤动组(AF组)和窦律组(SR组),两组之间临床因素没有统计学差异。换瓣术中取右心耳心肌标本,电镜观察闰盘和心房颗粒的变化。结果AF组患者右房心肌闰盘缝隙的裂开,缝隙中出现髓样、絮状物质。心房颗粒多位于核周及肌原纤维间,可见高尔基氏体,多伴有脂褐素沉着,两组之间无明显差异。结论风心病慢性AF与窦性心律患者右房肌细胞闰盘结构存在差异,这些改变可能是导致风心病患者右房AF的重要病理基础。而两组心房颗粒(ASG)之间无明显差异,显示ASG不是风心病房颤患者右房颤动的重要病理基础。

Objective To observe the atrial special granules （ASG） and intercalated disc（ID） in patients with rheumatic heart disease （RHD）. Methods Twenty-nine patients with mitral valve replacement of RHD were divided into AF group （n= 13） and sinus rhythm（SR） group（n=16） according to chronic AF or not. There were not significant statistical difference in clinical factors between two groups. During the operation of valve replacement, the samples of right atrial appendages were taken and the ID were observed with electron microscopy. Results Split of intercalated disc （ID） gap was found in AF group, and there were man＇owing and floccular substance in ID gap. Most ASG were near the nucleus and in the myofibril, dictyosome and Lipofuscin pigmentation could be seen near ASG. There were not significant difference of ASG quantitative study between the two groups. Conclusions There were not significant difference in the change of ASG of right atrial myocardium between AF and SR with RHD. This study indicated that these changes should not be the important pathological basis of RA fibrillation of AF patients with RHD.