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目的:探讨扩张型心肌病(dilatedcardiomyopathy,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。
Objective: To investigate the relationship between morphological changes of dilated cardiomyopathy (DCM) and cardiac function. Methods: Twenty patients with DCM underwent cardiac biopsy and histopathological analysis. The cardiac systolic and diastolic parameters were measured by radionuclide blood pool imaging. Long-term follow-up investigation was performed on these patients. Results: Myocardial biopsy results of all DCM patients showed that there were different degrees of myocardial hypertrophy, degeneration, myofibril sparseness, disordered alignment and myocardial interstitial fibrosis. The results of nuclide heart blood pool imaging showed that patients had different degrees of myocardial contraction Decreased force and cardiac dysfunction. The semiquantitative analysis of myocardial lesions showed that the LVEF of cardiac function in 26 patients with interstitial fibrosis, myofibril thinning and cardiomyocyte hypertrophy were (26 ± 10)%, (26 ± 10)%, (24 ± 24) ± (49 ± 7)%, (±) ± 7)%, PER of 1.54 ± 0.32, 1.51 ± 0.40 and 1.39 ± 0.23, respectively , (47 ± 6)% respectively; PER were (2.79 ± 0.33), (2.83 ± 0.31) and (2.81 ± 0.35) EDV / s, respectively (t = 7.927,7.927,8.145, P <0.01). Myocardial biopsy light microscopy morphometry and cardiac function between the two are highly relevant. Conclusions: Myocardial interstitial fibrosis and myofibrillation in patients with DCM are the major pathological basis of cardiac dysfunction in patients with dilated cardiomyopathy.