肺血减少型先天性心脏病远端肺血管的病理形态学变化

Pathological changes of the distal pulmonary vessels in complex congenital heart disease with diminutive pulmonary blood

目的:观察肺血减少型先天性心脏病远端肺细小动脉的病理学形态变化特点。方法:对28例肺血减少型先天性心脏病患者(研究组)及28例同年龄非心源性且对心脏及肺血管发育无直接影响疾病开胸手术的患者(对照组),于开胸后取右肺中叶小块肺组织约1 cm×1 cm×1 cm,Weihgt弹性纤维+Van Gieson染色,光学显微镜连接生物医学图像分析,选择直径≤100μm、断面较圆整的5支肺细小动脉测量外径、内径,取平均值后计算平均中膜厚度百分比(mMTPA),并计算肺细小动脉的血管总面积(外弹力板以内)、血管腔面积(内膜表面以内)、血管壁面积(外弹力板与内膜表面之间)、血管壁面积/血管总面积(WA/TA)、血管腔面积/血管总面积(EA/TA)、单位面积肺细小动脉数目(APSC)。结果:研究组肺细小动脉外径与对照组差异无统计学意义(P>0.05),且肺细小动脉内径明显高于对照组(P<0.01),肺细小动脉mMTPA、WA/TA和APSC均明显低于对照组(P<0.01)。结论:肺血减少型先天性心脏病肺细小动脉中膜変薄、管腔扩张、APSC减少。

Objective：To observe the features of pathological structure of pneum-arteriolar in complex congenital heart disease with diminutive pulmonary blood.Methods：Twenty-eight patients suffering from congenital heart disease with diminutive pulmonary blood（study group） and 28 matched volunteers（sex,age and body weight） without cardiopulmonary disease（control group） were select to obtain right middle lobe lung tissue pieces（1 cm×1 cm×1 cm） after thoracotomy.Optical microscope was connected biomedical image analysis,the pulmonary arterioles with the diameter≤100 μm and cross-section complete were select to measure the pulmonary arterioles outside and inside diameter of five pulmonary arterioles in lung tissue,and the average percentage of media thickness（mMTPA） was calculate.After taking the average the total vascular area of pulmonary arterioles,vascular lumen area,vessel wall area,vessel wall area/vessel total area（WA/TA）,vascular lumen area/vessel total area（EA/TA）,and perunit area the number of pulmonary arterioles（APSC） were calculate.Results：The outside diameter of pulmonary arterioles in study group was no significant difference compared with the control group（P0.05）,and the inside diameter of pulmonary arterioles in study group was higher（P0.01）,the mMTPA,WA/TA and APSC of pulmonary arterioles in study group was significantly lower（P0.01）.Conclusions：Tunica media of pulmonary artery was thiner and vascular lumen expanded,APSC of per unit area was reducing in congenital heart disease with diminutive pulmonary blood.