扩张型心肌病病理形态学变化与心功能的关系(英文)

Relationship between pathomorphological changes and cardiac function in patients with dilated cardiomyopathy

目的:探讨扩张型心肌病(dilatedcardiomyopathy,DCM)病理组织形态学变化与心功能之间的关系。方法:对20例DCM患者进行心肌活检后病理形态学分析及运用核素心脏血池显像测得各项心脏收缩和舒张功能指标,并对上述患者进行长期随访调查。结果:所有DCM患者心肌活检结果均提示存在不同程度的心肌细胞肥大、变性、肌原纤维稀疏、排列紊乱以及心肌间质纤维化,核素心脏血池显像结果显示患者存在不同程度的心肌收缩力下降及心功能障碍。心肌病变半定量分析表明间质纤维化、肌原纤维稀疏化及心肌细胞肥大2+～4+组心功能各项指标LVEF分别为(26±10)%,(26±10)%,(24±7)%;PER分别为(1.54±0.32),(1.51±0.40),(1.39±0.23)EDV/s明显差于1+组LVEF分别为(49±7)%,(49±7)%,(47±6)%;PER分别为(2.79±0.33),(2.83±0.31),(2.81±0.35)EDV/s(t=7.927,7.927,8.145,P<0.01)。心肌活检光镜形态测量指标与心功能之间两者高度相关。结论:DCM患者心肌间质纤维化,肌原纤维减少是扩张型心肌病心功能损害的主要病理基础。

AIM:To discuss the relationship between pathomorphological changes and cardia c function of patients with dilated cardiomyopathy(DCM). METHODS:Twenty patients with DCM were studied with myocardial biopsy and nucl ide cardiac blood pool imaging to measure morphological changes in their myocard ial pathological tissues and the indeices of cardiac systolic and diastolic func tion.All these patients received a long- term follow- up. RESULTS:Various pathological changes could be found through morphological obs ervation of myocardial bioptic tissues,such as hypertrophy,degeneration of myoca rdial cells,rarefaction,disturbance of myofibrils and fibrosis of myocardial mes enchymes in all the DCM patients.Cardiac blood pool imaging revealed cardiac con tractility decline and cardiac functional disturbance of different degrees among the patients.Myocardial lesion semi- quantity analysis of interstitial fibrosi s,rarefaction of myofibril and hypertrophy of myocardial cells indicated that in 2+-4+ groups left ventricular ejection fraction(LVEF) was( 26± 10) % , ( 26± 10) % , and( 24± 7) % ; peak ejection rate(PER) was( 1.54± 0.32),(1.51± 0.40), and(1.39± 0.23) EDV/s,obviously different from those of 1 + group[LVEF( 49± 7) % , ( 49± 7) % , and( 47± 6) % ; PER( 2. 79± 0.33),(2.83± 0.31), and(2.81± 0.35) EDV/s](t=7.927,7.927,8.145,P< 0.01).I t showed a close linkage between the morphological indexes of myocardial biopsy and cardiac function. CONCLUSION:Myocardial interstitial fibrosis and the reduction of myofibril el ements are the major pathological basis for the impairment of cardiac function i n patients with DCM.