老年高血压左心室肥厚患者心肌重构特点及与冠心病、糖尿病的对比研究

Pathological changes of cardiac collagen in the elderly patients with hypertensive left ventricular hypertrophy and comparative research among hypertension, coronary heart disease and diabetes

目的 观察老年高血压左心室肥厚（LVH）患者心肌胶原纤维病理改变特点,并在合并相同左室肥厚条件下,与冠心病、糖尿病进行对比研究.方法 从解放军总医院1954年至2001年的3520例连续尸检标本中选取年龄≥65岁的高血压病、冠心病、糖尿病及对照组179例的心脏标本进行HE、苦味酸天狼星红和Ⅰ、Ⅲ型胶原免疫组织化染色,运用光镜和偏振光观察胶原纤维的分布特点,用全自动图像分析计算心肌间质胶原容积分数（CVF）、Ⅰ、Ⅲ型CVF及Ⅰ/Ⅲ型比值.结果 与对照组指标比较,高血压LVHⅠ级患者心肌的CVF（6.32％ ±0.92％）、Ⅰ型CVF（5.93％ ±0.94％）显著增高（P＜0.01）,而Ⅲ型CVF（2.23％ ±0.38％）、Ⅰ/Ⅲ（2.69 ±0.42）差异无统计学意义（P＞0.05）;高血压LVHⅡ级以及高血压LVH Ⅲ级患者心肌的各项指标均显著增高（P＜0.01）.与高血压LVH-Ⅰ级患者心肌相应指标比较,冠心病LVH-Ⅰ级患者心肌的各项指标差异均无统计学意义（P＞0.05）;糖尿病LVH-Ⅰ级患者心肌的CVF（4.23％ ±0.69％）、CVF-Ⅰ （3.92％±0.40％）低于高血压LVH-Ⅰ级患者（P＜0.01）,而CVF-Ⅲ（1.79％ ±0.21％）、Ⅰ/Ⅲ（2.20±0.20）差异无统计学意义（P＞0.05）.结论 （1）随着高血压病左室肥厚程度的加重,心肌僵硬度愈明显、舒张功能受损愈重.（2）在合并LVH Ⅰ级时,糖尿病患者心肌的舒张功能受损程度显著轻于高血压和糖尿病患者.

Objective To investigate the pathological changes of cardiac collagen in the elderly patients with hypertensive left ventricular hypertrophy（LVH）and the difference of collagen among the groups of essential hypertension（EH）,diabetes （T2DM） under the condition of the same stage,providing pathological foundation of clinical treatment for curing diseases and the early heart protection.Methods A retrospective study was performed in 140 cases over 65 years old of EH and normal cases as control out of 3520 consecutive autopsied cases from 1954 to 2001 in Chinese People＇s Liberation Army （PLA） General Hospital.The pathological changes of collagen were studied with hematoxylin and eosion（HE） staining,Sirius Red F3B （SR）and immunohistochemistry staining.Myocardial interstital collagen deposition was observed with light microscope and polarization technique.Quantitative measurements on the myocardial collagen volume fraction （CVF）,CVFS of type Ⅰ and type Ⅲ,and the rate of collagen type Ⅰ to type Ⅲ （Ⅰ/Ⅲ） were determined with videodensitometry.Results The CVF（6.32% ± 0.92%） and CVF Ⅰ （5.93% ± 0.94%）were increased significantly in EH LVH Ⅰ group （P 〈0.01） ; but,CVF Ⅲ （2.23% ±0.38%） and Ⅰ/Ⅲ （2.69 ±0.42） did not change significantly in EH Ⅰ group compared with the control group; The changes in the aforementioned four items were increased significantly in EH LVH Ⅱ and EH LVH Ⅲ groups （P 〈0.01）compared with the control group.The CVF and CVF-Ⅰ were decreased significantly（P 〈 0.01） ; but CVF-Ⅲ and Ⅰ/Ⅲ did not change significantly in DM LVH-I group compared with the EH LVH-I group; the CVF（4.23% ± 0.69%） and CVF-Ⅰ （3.92% ±0.40%） were decreased significantly（P 〈0.01）; but CVF-Ⅲ（1.79% ±0.21%） and Ⅰ/Ⅲ （2.20 ±0.20） did not change significantly in DM LVH-Ⅰ group compared with the EH LVH-Ⅰ group.Conclusions （1）The myocardial stiffness and the reduction of cardiac diastolic function deteriorated most with the development of LVH.（2）Under the condition of the same stage,the myocardial stiffness and the reduction of cardiac diastolic function deteriorated seriously in EH groups,diabetes patients,myocardial stiffness and the reduction of cardiac diastolic function deteriorated slightly.