15例终末期心脏病的心肌组织病理学观察

Myocardial histopathologic features of end-stage cardiac dieases in 15 cases

目的：探讨终末期心脏病的心肌组织病理改变及特征。方法：对接受心脏移植的9例扩张型心肌病（DCM）患者、6例其他类型终末期心脏病患者[肥厚型心肌病（HCM）2例,缺血性心肌病、心脏横纹肌肉瘤、先天性心脏病房间隔缺损、法洛四联症各1例]及1例正常对照的心肌标本进行组织病理学和电镜检查,并与临床心功能分级对照分析。结果：DCM患者光镜下均可见广泛纤维组织增生,以血管周围最为明显,心功能Ⅲ-Ⅳ级的心肌纤维化程度为,较心功能Ⅱ级者（＋）为重;另可见心肌细胞形态异常,但少见间质炎症细胞浸润、心肌细胞排列紊乱及小血管变化;电镜下均可见肌原纤维稀疏,线粒体肿胀、形态不规则,其中呈线粒体空泡样变、巨大线粒体、肌质网明显扩张各1例。1例HCM患者光镜下呈现与DCM者类似的改变,但肌原纤维有断裂现象,细胞排列紊乱,胞核畸形,血管扩张,较多炎症细胞浸润;1例HCM患者及2例终末期先天性心脏病患者的心肌组织病理学改变与DCM患者相似。6例其他类型终末期心脏病患者电镜下的心肌超微结构改变均与DCM患者相似,但未见有巨大线粒体。结论：①心肌纤维化是终末期心脏病心肌组织病理学的主要特征,纤维化程度越重,心功能越差;②心肌细胞排列紊乱及炎症细胞浸润可能为HCM的特征性改变;③线粒体异常如巨大线粒体可能为终末期DCM的特征性改变。

Objective：To investigate the myocardial histopathologic changes and features of end-stage cardiac dieases.Method：Nine patients with DCM,six patients with other late-stage heart diseases were examined on left ventricular myocardial sample by light microscope and electronic microscope.Result：Under light microscope,extensive fibroplasia,mainly around interstitial blood vessel,were found in DCM patients（6 males,3 females,aged years）,and such interstitial fibrosis was closely correlated with NYHA cardiac function classification.In addition,cardiomyocyte paramorphia but for inflammatory cell infiltration in interstitium,alignment disturbance and small vessels change were also shown on light microscope.Scattered myofibrilla,swollen and irregular mitochondria were found in DCM specimens under electronic microscope,in which mitochondrial vacuolar degeneration,giant mitochondria and dilation of sarcoplasmic reticulum were present in 3 DCM myocardial specimens respectively.In the other 6 patients（5 males,1 females,aged years）,cardiac histopathologic findings,both under light microscope and electronic microscope,of 2 HCM and 2 congenital heart disease were similar to those in DCM patients except for broken myofibril,Alignment disturbance and inflammatory cell infiltration seen in 1 HCM patient,while giant mitochondria was merely found in DCM patients.Conclusion：①Interstitial fibrosis is the predominant finding in end-stage heart disease,which correlated with the severity of cardiac dysfunction.②Alignment disturbance and inflammatory cell infiltration are the features in HCM.③Giant mitochondria seem to be the evident feature of late-stage DCM.