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目的:观察慢性冬眠心肌(CHM)间质变化及其对心功能的影响。方法:对小型猪采用球囊扩张及内膜剥脱术,造成心脏左前降支中段狭窄、心肌慢性缺血,建立CHM模型。24只小型猪被分成:CHM组和假手术组,于模型建立后4周、12周终止实验。心脏切片以HE染色,透射电镜观察组织形态学;以苦味酸天狼星红(PSR)染色,偏光镜观察间质胶原纤维类型和比例;以免疫组化法测定间质糖蛋白、纤维结合蛋白(FN)和骨桥蛋白(OPN);以超声心动图观察左室收缩功能。结果:较之假手术组(1)CHM的间质空间扩大,成纤维细胞增多,胶原增生;(2)CHM的间质胶原容积分数(ICVF)、血管周围胶原容积分数(PCVF)及光密度积分(IOD)、FN和OPN均明显增加,并随时间延长而增加(P<0.01);(3)PSR染色偏光镜观察示CHM组Ⅰ型胶原大量聚集,排列紊乱,Ⅲ型胶原少量,Ⅰ/Ⅲ胶原比例增高;(4)CHM组的左室射血分数(LVEF)、左室短轴缩短率(LVFS)、室壁增厚率(%WT)显著降低(P<0.01);(5)胶原纤维含量与LVFS、LVEF和%WT呈高度负相关(r=-0.754～-0.872,P<0.01)。结论:慢性冬眠心肌出现间质重塑。
Objective: To observe the interstitial changes of chronic hibernating myocardium (CHM) and its influence on cardiac function. Methods: Balloon expansion and endarterectomy were performed on miniature pigs, resulting in the stenosis of middle left anterior descending coronary artery and chronic myocardial ischemia. CHM model was established. 24 miniature pigs were divided into: CHM group and sham operation group, and the experiment was terminated at 4 weeks and 12 weeks after model establishment. Heart sections were stained with hematoxylin-eosin (HE) and examined by transmission electron microscopy (TEM). PSR staining and polarized light microscope were used to observe the type and proportion of interstitial collagen fibers. Interstitial glycoproteins and fibronectin (FN ) And osteopontin (OPN). The left ventricular systolic function was observed by echocardiography. Results: Compared with the sham-operation group (1), interstitial space of CHM enlarged, fibroblasts proliferated and collagen hyperplasia. (2) ICVF, PCVF and optical density of CHM (IOD), FN and OPN increased significantly (P <0.01). (3) PSR staining showed that type Ⅰ collagen aggregated and disordered in CHM group, collagen Ⅲ was small, Ⅰ (4) The left ventricular ejection fraction (LVEF), left ventricular fractional shortening (LVFS) and ventricular wall thickening rate (% WT) were significantly decreased in CHM group (P <0.01) Collagen content was negatively correlated with LVFS, LVEF and% WT (r = -0.754-0.872, P <0.01). Conclusion: There is interstitial remodeling in chronic hibernating myocardium.