100例先天性心脏病肺动脉高压肺活检病理分级的初步探讨

PATHOLOGICAL CLASSIFICATION OF INTRAPULMONARY ARTERIES IN LUNG BIOPSY OF 100 CASES OF CONGENITAL HEART DISEASE WITH PULMONARY HYPERTENSION

本文报告100例先天性心脏病(下简称先心病)肺动脉高压肺活检的肺内动脉病理改变.以及与心导管资料及手术近期效果的对照分析结果。将肺动脉病变分为Ⅰ级(中层肥厚)、Ⅱ级(中层肥厚及内膜有细胞性增生)、Ⅲ级(中层肥厚及阻塞性内膜纤维化、多发血栓形成,或伴弥漫性肺间质纤维化)、Ⅳ级(前述改变中部分病变加上出现丛状改变,或伴局限性动脉壁坏死、变性、炎症)。研究说明,Ⅰ、Ⅱ级为可逆性病变,预后好;Ⅳ级为不可逆性,不适宜行心脏矫正手术。Ⅲ级是临界性病变,难以预测其预后。对肺活检的应用价值及应注意的问题进行了讨论。

A correlative analysis of the pathologic changes of intrapulmonary arteries in lung biopsy, data of cardiac catheterization and effects of surgery in 100 cases of congenital heart disease with pulmonary hypertension was reported. Pathological lesions of the pulmonary arteries were graded as follows: Grade Ⅰ showed medial hypertrophy; Grade Ⅱ medial hypertrophy and intimal cellular proliferation; Grade Ⅲ medial hypertrophy plus occlusive intimal fibrosis and multiple thrombosis; Grade Ⅳ the above lesions plus plexiform lesions with/without focal fibrin necrosis or degeneration or necrotizing arteritis. This study indicates that Grade Ⅰ and Ⅱ are reversible while grade Ⅳ is irreversible which should be considered to have palliative procedures. Grade Ⅲ is of border line lesion. The significance and points to be emphasized on lung biopsy were discussed.