风湿性二尖瓣病变心肌和肺组织的病理学观察

Pathologic Study of the Lung Tissue and Myocardium in Rheumatic Cardiac Valvular Disease

目的 探讨风湿性二尖瓣病变患者右心房心肌超微结构改变与肺组织的病理变化(光学显微结构和超微结构)之间的相互关系。 方法 24例患者均在建立体外循环前取右心耳心肌和肺组织经超薄切片后用透射电子显微镜观察,肺组织同时制作石蜡片用光学显微镜观察。 结果 右心房心肌的病变程度与肺组织的病变程度基本一致;肺光学显微镜下级、级病变者心肌和肺组织超微结构改变较级、级者有加重的趋势,增厚的气血屏障基底膜中可见成纤维细胞插入。 结论 右心房心肌肌丝广泛性溶解在一定程度上更能反映患者的病情;肺毛细血管基底膜和肺间质的改变较突出;成纤维细胞的迁移。

Objective To study the pathologic changes of the lung tissue and the right atrial myocardium biopsy specimens in each patient with rheumatic cardiac valvular disease. Methods Light microscopic and ultrastructural observations were made on right atrial myocardium and lung tissues from 24 patients. Results The pathologic changes of the myocardium agreed with the pulmonary tissue changes.The ultrastructural changes of the lung tissue and myocardium in grade Ⅲ and grade Ⅳ were more severe than that in grade Ⅰ and grade Ⅱ.The basemembrane of capillary was thickened. Meanwhile, the basemembrane of the blood air barrier was splited by the fibroblasts or myofibroblasts. Conclusion It is possible to recognize the status of the heart and pulmonary vasculature by studying the degenerative alterations of the right atrial myocardiums. The thickening of the pulmonary vessel wall and basement membrane of capillary are related to the hyperplasia, migration, transition of the fibroblasts and intermediate cells.