非心律失常性右心室心肌病心肌脂肪浸润117例尸检病理分析

Pathology of myocardial fatty infiltration： an autopsy report from 117 cases

目的探讨心肌脂肪浸润形成的相关因素及其对机体的影响。方法收集2001年10月至2009年6月受理的117例符合心肌脂肪浸润（又称脂肪心）诊断的尸检案例。进行大体观察和HE镜下观察。结果心外膜下脂肪组织增生程度的肉眼分级与心肌脂肪浸润程度的镜下分级存在显著正相关性（rs=0．57，P〈0．01）。心肌脂肪浸润程度与年龄、冠状动脉粥样硬化无明显相关性。有心肌脂肪浸润的心脏伴有心肌萎缩率达39．32％（46／117），其中轻度组伴心肌萎缩率（13／63，20．63％）显著低于中度组（22／39，34．92％；x^2=12．14，P〈0．01）和重度组（11／15，73．33％；x^2=13．42，P〈0．01）。心肌脂肪浸润性猝死占心原性猝死的21．43％（6／28）。结论心肌脂肪浸润并不是年龄老化和冠状动脉粥样硬化所伴随的病理学改变。心肌脂肪浸润常导致心肌萎缩，可引起心原性猝死。

Objective To explore the risk factors related to the formation of myocardial fatty infiltration and possible pathological consequences. Methods The macroscopic and microscopic findings in 117 autopsy cases with myocardial fatty infiltration were examined during October, 2001 to June, 2009. Results There was a significant positive correlation between the macroscopic grading of subepicardial adipose tissue and the microscopic myocardial fatty infiltrative degree （ rs = 0. 57, P 〈 0.01 ） but there was no correlations between the myocardial fatty infiltrative degree and age as well as coronary arteriosclerosis （all P 〉 0. 05 ）. The percent of myocardial atrophy was 39. 32% （46/117 ）, and the rate of myocardial atrophy in mild myocardial fatty infiltration group （ 13/63,20. 63% ） was significantly lower than that in moderate myocardial fatty infiltration group （22/39,34. 92% ; X^2 = 12. 14, P 〈 0.01 ） and in severe myocardial fatty infiltration group（ 11/15,73.33% ;X^2 = 13.42 ,P 〈0. 01 ）. There were 28 sudden cardiac deaths among the 117 eases including 6 deaths due to myocardial fatty infiltration. Conclusions Myocardial fatty infiltration is often associated with myocardial atrophy, even with sudden cardiac death but is not an accompanying pathologic changes of aging and coronary arteriosclerosis.