风湿性心脏病持续性心房颤动患者右房心肌细胞线粒体结构的研究

探讨风湿性心脏病 (简称风心病 )持续性心房颤动 (AF)患者右房AF的病理基础。选择 2 9例风湿性二尖瓣置换术患者 ,根据有无持续性AF分为AF组和窦律 (SR)组 ,两组之间临床因素没有统计学差异。换瓣术中取右心耳心肌标本 ,进行光镜和电镜的定性和定量研究。结果 :①光镜 :AF组明显的间质纤维化和心肌纤维排列紊乱 ,但两组右房心肌横径及间质所占比例没有统计学差异。②AF组线粒体体积缩小 ,嵴断裂、溶解较SR组显著 ;定量研究发现 ,AF组及SR组的体密度、比表面、平均截面积、平均周长分别为 :177.41± 48.45 (10 -3) ,10 0 .0 2± 14.93(10 -4nm-1) ,195 737.74± 5 6 42 1.5 6 (nm2 )及 180 7.5 2± 2 47.0 4(nm)VS 2 5 6 .0 6± 5 3.17(10 -3) ,85 .16± 15 .2 1(10 -4 nm-1) ,2 80 188.6 7± 2 7993.79(nm2 )及 2 2 5 7.82± 431.92 (nm) ,两组之间以上指标存在显著性差异。而两组患者的面密度和面数密度没有显著性差异。结论 :风心病慢性AF与窦性心律患者右房肌细胞线粒体的超微结构变化及间质纤维化和细胞排列紊乱程度存在显著差异。显示这些改变可能是导致风心病患者右房AF的重要病理基础。

Influence of Sustained Atrial Fibrillation on Mitochondria Structure of Right Atri um Myocardium in Patients With Rheumatic Heart Disease.

We aim to study the pathological basis of right atrial fibrillation(AF) in patients with rheumatic heart disease(RHD).Twenty nine patients with mitral valve replacement of RHD were divided into AF group( n =13) and sinus rhythm(SR) group( n =16) according to chronic AF or not.There weren′t significant statistical difference in clinical factors between two groups.During the operation of valve replacement,the samples of right atrial appendages were taken and the qualitative and quantitative study were made by light microscopy and electron microscopy.Results:①The interstitial fibrosis and the arrangement of myocardium confused in AF group were obviously than in SR group.However,no statistic difference was found in interstitial fibrosis and cellar hypertrophy degree between two groups.②Crosta broken and dissolved could be found obviously in AF group.The mitochondrial volume in AF group was smaller than in SR group.It was shown by quantitative study that volume density,specific surface,average area and average perimeter in AF group and SR group were 177.41±48.45(10 -3 ),100.02±14.93(10 -4 nm -1 ),195737.74±56421.56(nm 2) and 1807.52±247.04(nm) VS 256.06±53.17(10 -3 ),85.16±15.21(10 -4 nm -1 ),280188.67±27993.79(nm 2) and 2257.82±431.92(nm),respectively.There were significant difference of above factors between two groups.There were not significant difference of surface density and numerical density on area in the two groups.Conclusions:There were significant difference in the change of mitochonatrial ultrastruture and the arrangement of myocardium confused of right atrial myocardium between AF and SR with RHD.This study indicates that these changes should be the important pathological basis of RA fibrillation of AF patients with RHD.