扩张型心肌病病理形态学变化与心功能的关系

目的探讨扩张型心肌病( dilated cardiomyopathy, 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.

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

AIM:To discuss the relationship between pathomorphological changes and cardiac function of patients with dilated cardiomyopathy(DCM). METHODS:Twenty patients with DCM were studied with myocardial biopsy and nuclide cardiac blood pool imaging to measure morphological changes in their myocardial pathological tissues and the indeices of cardiac systolic and diastolic function.All these patients received a long-term follow-up. RESULTS:Various pathological changes could be found through morphological observation of myocardial bioptic tissues,such as hypertrophy,degeneration of myocardial cells,rarefaction,disturbance of myofibrils and fibrosis of myocardial mesenchymes in all the DCM patients.Cardiac blood pool imaging revealed cardiac contractility decline and cardiac functional disturbance of different degrees among the patients.Myocardial lesion semi-quantity analysis of interstitial fibrosis,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+ groupLVEF( 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).It showed a close linkage between the morphological indexes of myocardial biopsy and cardiac function. CONCLUSION:Myocardial interstitial fibrosis and the reduction of myofibril elements are the major pathological basis for the impairment of cardiac function in patients with DCM.