心房颤动患者心房细胞结构的改变

目的探讨心房颤动(房颤)发生后相关细胞结构和超微结构变化及其临床意义。方法收集53例心脏外科手术患者,根据心律分为窦性心律组(窦律组,26例)和房颤组(27例)。术前行超声心动图检查。手术中取右心耳组织,行石蜡包埋切片,HE染色后测定细胞直径,Masson染色测定胶原容积分数。用免疫组织化学方法检测结蛋白、N-钙黏素的分布变化。电镜观察超微结构变化。结果与窦律组比较,房颤组心房细胞直径增加,与心房大小成正相关,心房纤维化明显,心肌出现不同程度的肌溶解现象,电镜观察发现细胞器、细胞连接异常。免疫组织化学检测显示房颤组中N-钙黏素分布不均一,结蛋白分布异常。结论房颤后心房细胞结构改变是房颤复发和心房抑顿的结构基础。

The structural change of atrial myocyte in patients with atrial fibrillation

Objective To investigate the change of atrial myocyte structure and ultrastructure during atrial fibrillation(Af)in human right atria.Methods Right atrial tissue samples of 53 patients undergoing cardiac surgery were examined:27 with Af and 26 without Af(sinus group).The diameter of myocyte and collogen volume fraction(CVF)were measured.Ultrastructure was studied by electron microscopy.N-cadherin and desmin were analyzed by immunohistochemistry.Results Compared with sinus group,the cellular diameter and CVF increased in Af group.Different degrees of myolysis were found under electron microscope.Diameter of cardiomyocytes correlated with diameter of right atria.Immunohistochemistry revealed that desmin and N-cadherin were redistributed inhomogeneously.Conclusion The change of structure of cardiomyocytes is the basis of Af recurrence and atrial stunning.