风湿性心脏病肺血管胶原的变化与肺动脉高压的关系

Collagen changes of pulmonary arteriol in patients with rheumatic heart disease and its correlation with pulmonary hypertension.

目的:探讨风湿性心脏病(风心病)的肺血管胶原(Col)改变及其与肺动脉高压的关系。方法:收集有完整术前血流动力学资料和术中肺活检标本的风心病患者79例,对肺组织标本进行Col I、ColⅢ免疫组织化学染色并测定肺小动脉的Col量。将肺动脉压力与肺血管中Col含量、临床资料等进行分析。结果:肺小动脉ColI、ColⅢ含量与肺动脉收缩压(PASP)及肺动脉平均压(mPAP)之间有线性相关关系。肺血管Col除了与肺动脉压力有关外,还与肺血管病变分级、心功能、年龄因素有关。结论:Col增生参与了风心病肺动脉高压的形成与维持。风心病肺小动脉Col I、colⅢ含量与PASP及mPAP之间有线性相关关系。风心病肺小血管Col的增生还可能受到多种临床因素的综合影响。

Objective:To investigate the collagen changes in pulmonary arteriole and its relation with pulmonary hypertension in patients with rheumatic heart disease. Methods:The preoperative hemodynamic pararameters were obtained by catheterization. In study group 79 lung specimens were taken from the right lower lobe after bypass, and in control group, 10 specimens were from autopsy or biopsy. Immunohistochemical staining with antibodies against collagen type I and type III were used by S-ABC method. The levels of collagen type I and type III quantitatively examined under computerized image analysis system. The correlations were analyzed between collagen in pulmonary arteriole and the clinical data. Results: There were significantly higher levels of collagen type I , type III in pulmonary vessels in study group than thoset control group. The content of collagen I and collagen III was positively correlated with pulmonary artery systemic presure and mean pulmonary artery pressure. Besides the pulmonary artery pressure, the other factors such as severity of pulmonary vascular lesions, cardiac function and age were also correlated with the concentration of collagen in pulmonary arteriole wall. Conclusion proliferation of collagen contributed to formation and maintenance of pulmonary hypertension and vascular lesions is resulted in rheumatic heart disease. The content of collagen I and collagen III was positively correlated with pulmonary artery systemic presure and mean pulmonary artery pressure. Perhaps other clinical factors were as important as pulmonary artery pressure in affecting the concentration of collagen in arteriole wall.