移植心脏冠状动脉血管病尸检病理分析

目的:提高对移植心脏脏冠状动脉血管病病变的认识。方法:对尸检病例心脏进行HE染色并用免疫组织化学染色及EBER原位杂交检测等方法,对浸润淋巴细胞进行病理分析并文献复习。结果:①移植心脏冠状动脉血管病主要病变表现为不同程度,不同部位的冠状动脉内膜弥散性、同心圆样内膜增生、散在淋巴、单核细胞浸润、部分伴脂质沉积、血栓形成及较少钙化;②心肌细胞可表现为局灶变性、坏死及纤维瘢痕形成,部分出现明显心肌纤维化;③血栓可出现于冠状动脉主干及各分枝、附着于心室壁及肺动脉内;④移植心脏冠状动脉血管病可伴有急性细胞排斥反应,浸润淋巴细胞可单纯出现在心肌间质内,也可以表现为增厚冠状动脉血管内膜同时伴发淋巴细胞浸润,多次发生急性细胞排斥反应,可以加重移植心脏冠状动脉血管病的发病。结论:移植心脏冠状动脉血管病变临床不易早期发现,确诊需要冠状动脉血管造影、血管内超声等影像学检查;移植心脏冠状动脉血管病常伴发急性细胞排斥反应。

The pathological analysis on transplant coronary artery disease of autopsy cases

Objective: To further understanding the transplant coronary artery disease and combined lesions.Methods: HE staining and immunohistochemical staining and EBER in situ hybridization detection methods were used to analysis infiltrating lymphocytes of autopsy cases of heart and literature review.Results: Transplant coronary artery disease showed varying degrees of major disease,coronary artery intima in different parts of the diffuse,concentric intimal hyperplasia-like,scattered lymphoid,mononuclear cell infiltration,some with lipid deposition and thrombosis,and less calcification.Myocardial cells showed focal degeneration,necrosis,fibrous scar formation,individual cases of significant myocardial fibrosis.Coronary artery thrombosis can occur in various branches,attached to the ventricular wall and the pulmonary artery.Transplant coronary artery disease may be associated with acute cellular rejection,infiltrating lymphocytes may simply appear in the myocardial interstitial,can be expressed as intimal thickening of coronary arteries associated with cells within the same infiltration,multiple acute cellular rejection,can increase the incidence of transplant coronary artery disease.Conclusion: It was difficult to early detecting the heart transplant coronary artery disease in clinical,the exact diagnosis requires coronary angiography,intravascular ultrasound.Acute cellular rejection often followed with transplant coronary artery disease.