扩张型心肌病纤维化心肌Ⅰ、Ⅲ型胶原及相关血清指标的变化

Change of collagen Ⅰ, Ⅱ and serum of myocardial fibrosis in dilated cardiomyopathy

目的 了解扩张型心肌病 (DCM)心肌纤维化 、 型胶原改建的病理基础及相关血清指标的变化 ,为防治该病提供新的理论依据 .方法 用病理染色、免疫组化对 7例扩张型心肌病行心脏移植的患者左室心肌和 7例正常心肌进行病理形态学和 、 型胶原免疫组化观察 ,放免法检测血清 型、 型前胶原 (P P、P P、层粘连蛋白 (L N)的含量 .结果 扩心病心肌细胞变性 ,肥大伴局灶性坏死 .心肌间质中胶原纤维弥漫增生 ,排列紊乱 .这是扩心病的主要病理特征 .免疫组化定位发现 、 型胶原在扩心病心肌间质呈明显增生分布 , 型胶原多于 型胶原 (P<0 .0 1) .心肌细胞内亦有 型胶原的阳性表达 .血清 P P,P P,L N均明显增高 (P<0 .0 5 ) .结论 心肌细胞变性、肥大 ,间质胶原大量增生改建是扩张型心肌病心肌纤维化的病理基础 ,也是心功能障碍的主要原因 .

AIM To study the pathological base of myocardial fibrosis of dilated cardiomyopathy (DCM), and to explore the distribution of Types Ⅰ and Ⅲ collagen in cardiac interstitium and concentrations of pro collagen Ⅲ (PⅢP) the serumin, pro collagen Ⅳ (PⅣP), Laminn (LN). METHODS Pathological staining and immuno histochemistry were used to observe the myocardial tissue pathology in 7 cases. Contents of PⅢP, PⅣP, LN in the serum were measured by radiommunoassay (RIA). RESULTS Diffused collagen fibroplasias, cardiac myocytes degeneration were noted and sometimes associated local necrosis in myocardium. It was a significant pathologic characteristic of DCM. The locali zation of Types Ⅰ and Ⅲ collagens in the myocardiac tissue was studied by ABC method of immunohistochemistry. Significant fibrophlasia of Types Ⅰ and Ⅲ collagens was found in myocardial interstitium of DCM. The composition and secretion of Type Ⅰ collagen were expressed not only in fibroblasts but also in myocardial cells. The in the contents of PⅢP, PⅣP, LN were significantly higher than those in normal individuals. CONCLUSION Pathologic foundation of myocardial fibrosis in DCM is fibroplasias and structural remodelling of collagen, which might be important reasons for heart dysfuncation caused by DCM.