心律紊乱与心肌超微结构

对40例心律紊乱怀疑病毒性心肌炎(VMT)患者行心内膜心肌活检术(EMB)标本电镜进行超微结构观察,结果40例心律紊乱患者中,诊断为活动性心肌炎24例,早期扩张性心肌病8例,扩张性心肌病5例,心肌炎后遗症3例。显示电镜超微结构的检测对心肌病变的诊断率(40/40)为100％。提示了EMB对VMT诊断的可靠性和敏感性比较高。且证明EMB是一种安全、可靠、简易的方法,对VMT诊断可提供有价值的资料。     

病毒性心肌炎及扩张型心肌病心内膜心肌活检组织的病理学观察

本文对35例病毒性心肌炎(VMC)和10例扩张型心肌病(DCM)心内膜心肌活检(EMB)标本进行病理组织学观察,发现主要病理改变 DCM 为心肌细胞肥大、细胞大小不一、核畸形、灶状纤维化和心肌变性坏死;VMC 则为炎性细胞浸润、心肌变性坏死、间质纤维化。EMB 病理诊断与临床诊断符合率 VMC 为65.7%,DCM 为80.0%,合计68.8%。     

心内膜心肌活检术的临床应用

本文报道20例心内膜心肌活检(EMB)的结果,19例获得成功,成功率为95％。术中全部病例均见短暂室性早搏(室早)或短阵室性心动过速(室速),未发生其他并发症。20例术前拟诊为:心肌病8例,冠心病5例、心肌炎4例,其他3例。活检成功的19例中,EMB为9例,提供了有力的诊断依据,纠正3例的诊断,在7例对诊断无助。EMB方法简单、安全,但必须结合临床及其他检验资料综合考虑才能提高确诊率。     

心肌活检若干临床价值探讨：（附21例分析）

通过心内膜心肌活检(EMB)21例组织学诊断,就如下问题提出讨论和评价:(1)EMB对心肌炎有特异性诊断价值,以年龄作为心律失常病因诊断要慎重;(2)EMB是慢性风心病风湿活动准确而可信的诊断方法;(3)原因不明的心衰EMB可以明确或有助于病因诊断,且对探索心衰机理可提供依据;(4)对“阵发性室上性心动过速(SVPT)常见于基本健康的人”这一传统看法提出质疑;(5)活检标本的观察要熟悉伪迹变化,临床医师应了解该技术的局限性。     

心内膜心肌活检对心律失常病因的探讨

本文对77例心律失常病人进行心内膜心肌活检,结合病史、体征及实验室检查从组织学上对心律失常病因进行分析。我们认为,无心脏增大组心律失常以心肌炎为主,占55.8%,心脏增大组心律失常以心肌病为主,占73.5%。心律失常类型与心肌病变有关,对症状明显的心律失常病人进行心肌活检有助于心律失常的早期诊断和治疗。     

扩张型心肌病30例临床分析

扩张型心肌病(DCM)是原发性心肌病中最常见类型,居心肌病之首位,近年来国内外发病率有增加趋势.心内膜心肌活检术(EMB)虽能提供特异性病理改变的根据,但因阳性率低,可出现伪迹,技术原因等均不尽如人意.且国内又主要用于心肌炎的诊断,故DCM仍采用排他性诊断.     

心内膜心肌活检41例临床分析

本文报告41例各种心脏疾病心内膜心肌活检的结果.活检成功率为93.0%,共获118块标本.标本经光学和电子显微镜观察,有87.5%获得有助于诊断的资料.特别是对鉴别心内膜心肌纤维化与缩窄性心包炎,早期扩张型心肌病与心肌炎,病理性或功能性心律失常等,有很大的辅助作用.提示该项检查安全、简便、成功率高、易于推广,有助于各种心内膜及心肌疾病的诊断和鉴别.     

心肌活检术诊断心肌炎的现状

心肌炎指心肌中有局限性，或弥漫性的急性、亚急性或慢性炎性病变。它常是全身性疾病中的一部分。心内膜心肌活检术（EMB）经多年来的实践和不断改进，已成为一种比较安全、相对简便的检查技术。由于EMB能从组织病理学上证实心肌炎症的存在，确定其严重程度及监测治疗反应，并可对心肌炎与心肌病之间的关系进行深入探讨，故不失为诊断和研究心肌炎的一种新手段。目前，心肌炎已列为EMB的重要适应证之一。     

心内膜心肌活检对心肌疾病的诊断价值

探讨心内膜心肌活检（ＥＭＢ）对心肌疾病的诊断价值，回顾性分析１９８４年５月～１９９５年１０月１７６例右室ＥＭＢ的组织病理资料。结果诊断心肌炎６４例（３６．３６％），扩张型心肌病４８例（２７．２７％），肥厚型心肌病２例（１．１４％），心内膜心肌纤维化１３例（７．３９％），正常或非特异性改变４９例（２７．８４％）。诊断阳性率为７２．１６％（１２７／１７６）。其中在９２例原因不明的心律失常患者中，活检显示心肌炎（４２．３９％）和扩张型心肌病（２８．２６％）发生率较高。发生急性心包积血１例（０．５７％）。说明ＥＭＢ对心肌疾病尤其是心内膜心肌纤维和心肌炎的诊断具有重要意义。     

病毒性心肌炎和扩张型心肌病心内膜心肌活检标本的单个核细胞表型分析

本研究就25例病毒性心肌炎和10例扩张型心肌病心内膜心肌活检(EMB)标本,运用单克隆抗体及免疫组织化学技术,进行单个核细胞表型的原位分析发现心肌组织内单个核细胞主要为 T 淋巴细胞,多分布于心肌间质内,常毗邻心肌病变部位,多为散在分布,少数呈条索或灶状分布。病毒性心肌炎有 T 辅助/诱导细胞     

Importance of endomyocardial biopsy in unexplained cardiomyopathy in China: a report of 53 consecutive patients

Background Although endomyocardial biopsy （EMB） plays a crucial role in the final diagnosis in patients with heart failure of unknown etiology, the invasive nature of this technique limits its clinical application in China. The purpose of this study was to evaluate the clinical application of EMB in diagnosing cardiomyopathy with unexplained etiologies in China. Methods Fifty-three consecutive patients （38 males, age 14-67 years, median 43 years） were included in the study who were initially diagnosed as unexplained cardiomyopathy and under EMB biopsy in Peking Union Medical College Hospital from 2006 to 2009. The patients were clinically divided into four groups： dilated, hypertrophic, restrictive and unclassified cardiomyopathy. Biopsies were performed via right internal jugular vein with the use of the bioptome under fluoroscopic guidance. Three to five endomyocardial samples were taken from each patient for light microscopy examination and one sample for electron microscopy was taken if necessary. For each patient, an initial clinical diagnosis, an EMB diagnosis and a final diagnosis prior to discharge were established. All the data were compared and analyzed for the evaluation of clinical utility of EMB in China.Results In 26 patients initially diagnosed with restrictive cardiomyopathy （RCM）, the etiology of the condition was finally diagnosed using EMB in 15; including 13 amyloidosis and two eosinophilic myocarditis. We employed EMB in 19 patients clinically diagnosed as dilated cardiomyopathy and detected viral myocarditis in one patient, cardiac involvement due to polymyositis in four and doxorubicin-induced cardiomyopathy in one. In five patients with severe left ventricle hypertrophy undergoing EMB, one patient was diagnosed as autophagic vacuolar cardiomyopathy and one as mitochondrial disease. In the remaining three patients with unclassified cardiomyopathy, EMB revealed infiltration of eosinophils as the cause of atrial ventricular block in one patient. Final diagnoses were made in 24 of the total 53 patients （45%） based on the combination of EMB and clinical data. Transient atrial ventricular block in a patient with prior complete left bundle branch block was the only complication occurred during the procedures.Conclusion The clinical application of EMB is safe. The combination of EMB and clinical data produced a better understanding of the mechanisms behind the clinically diagnosed cardiomyopathy in China.     

心内膜心肌活检组织内小冠状动脉病病理学观察

63例心内膜心肌活检中发现11例小冠状动脉病，其中5例伴心肌病病变，2例伴心肌炎病变。小冠状动脉病的病理表现为内膜增厚、管腔狭窄，经形态定量测定，11例44个小冠状动脉管腔狭窄率均在85％以上，与对照组比较有显著性差异（P＜0．001）。病理形态学提示小冠状动脉病形成与病毒感染后或脂类沉着后内膜增生有关。心内膜心肌活检具有诊断此类疾病的重要价值。     

nRT-PCR法检测心肌活检组织中柯萨奇B组病毒RNA的临床意义

目的 进一步探讨柯萨奇病毒（ＣＶＢ）感染与心肌炎及扩张型心肌病（ＤＣＭ）发病的关系,同时为临床诊断病毒性心肌疾病探求一个快速、敏感和特异的辅助检查方法。方法 应用巢式逆转录聚合酶链反应（ｎＲＴ－ＲＣＲ）检测２７例心肌活检组织中ＣＶＢ ＲＮＡ,并以９例正常及１例先心病心肌标本为对照;同时应用间接免疫荧光法检测其中１０例患者血清ＣＶＢ１－６ＩｇＭ。结果 １４例心肌炎及１３例ＤＣＭ患者中各有５例心肌组织     

Myocardial gallium-67 imaging in dilated cardiomyopathy

The use of gallium-67, an isotope that is avid for areas of inflammation in patients with dilated cardiomyopathy, is described and compared with endomyocardial biopsy in 68 consecutive patients with dilated cardiomyopathy. Myocarditis was diagnosed in 8% on biopsy and the likelihood of a positive biopsy when the gallium scan was positive for inflammation, rose to 36%. It is concluded that gallium scanning is a useful adjunct to biopsy in detecting myocarditis in patients with dilated cardiomyopathy and in following patients with evidence of myocarditis on biopsy.     

经静脉心内膜心肌活检112例

本文分析1982年11月至1985年10月首次应用改制胃镜活检钳,对112例患者经静脉作心内膜心肌活检的资料,为93例(83%)提供了有利于临床诊断的依据。原因不明的心律失常患者,显示相当高的心肌炎发生率(37.5%)。     

The morphological progression of viral myocarditis

In an attempt to document the morphological progression from acute idiopathic myocarditis to end-stage dilated cardiomyopathy we studied 20 patients with a diagnosis of myocarditis who had had serial endomyocardial biopsies performed with intervals of 1 month to 2 years and whose ages varied from 6 months to 62 years. Fifteen of these patients were treated with immunosuppressive drugs for myocarditis. Ten out of 15 treated patients stabilized clinically. In the remaining 5 cases there was worsening congestive heart failure and 1 patient underwent cardiac transplantation. Of the 5 patients who did not receive immunosuppression, 2 stabilized spontaneously, and 3 developed heart failure, 2 of whom subsequently had cardiac transplants. Whether the patients received immunosuppression or not, in all cases, the inflammatory infiltrate was less but the myocardium developed significant hypertrophy with an increase in interstitial fibrosis and in 8 cases the morphological changes were those of dilated cardiomyopathy. From the morphological standpoint of this study we have shown some evidence that dilated cardiomyopathy can be the end result of acute myocarditis. It appears that not every case of acute myocarditis progresses to dilated cardiomyopathy and that steroid treatment does not necessarily prevent progression of myocarditis to dilated cardiomyopathy.