CAJ | 학술논문

目的研究风湿性心脏病二尖瓣和主动脉瓣瓣膜胶原含量及其类型对瓣膜成形术病例选择的影响。方法采用羟脯氨酸法测定瓣膜胶原含量的变化，并用十二烷基磺酸钠-聚丙烯酰胺凝胶电泳(SDS-PAGE)分离法测定心瓣膜胶原的类型。结果正常二尖瓣腱索的胶原含量较瓣叶高（P<0.01），主动脉瓣胶原含量较二尖瓣低（P＜0.01）。风湿性心脏病患者二尖瓣和主动脉瓣的胶原含量较正常瓣膜有显著升高（P＜0.01）。正常瓣膜以Ⅰ型胶原为主，Ⅲ型胶原含量较少，而病变二尖瓣和主动脉瓣其Ⅰ型、Ⅲ型胶原均明显增加，且以Ⅰ型胶原为主。有钙化的二尖瓣腱索胶原含量高于无钙化瓣膜（P＜0.05）。二尖瓣病变以狭窄为主的病例其二尖瓣腱索的胶原含量较以关闭不全为主的病例高（P＜0.01），且二尖瓣瓣叶及腱索的胶原含量与二尖瓣口面积呈负相关（r=-0.5431和r=-0.8819，P＜0.01）。结论风湿性心脏病心瓣膜胶原含量和类型的变化与心瓣膜功能的改变密切相关，瓣膜有无钙化以及二尖瓣病变的性质，可作为施行心瓣膜成形术的选择条件。
목적연구풍습성심장병이첨판화주동맥판판막효원함량급기류형대판막성형술병례선택적영향。방법채용간포안산법측정판막효원함량적변화，병용십이완기광산납-취병희선알응효전영(SDS-PAGE)분리법측정심판막효원적류형。결과정상이첨판건색적효원함량교판협고（P<0.01），주동맥판효원함량교이첨판저（P＜0.01）。풍습성심장병환자이첨판화주동맥판적효원함량교정상판막유현저승고（P＜0.01）。정상판막이Ⅰ형효원위주，Ⅲ형효원함량교소，이병변이첨판화주동맥판기Ⅰ형、Ⅲ형효원균명현증가，차이Ⅰ형효원위주。유개화적이첨판건색효원함량고우무개화판막（P＜0.05）。이첨판병변이협착위주적병례기이첨판건색적효원함량교이관폐불전위주적병례고（P＜0.01），차이첨판판협급건색적효원함량여이첨판구면적정부상관（r=-0.5431화r=-0.8819，P＜0.01）。결론풍습성심장병심판막효원함량화류형적변화여심판막공능적개변밀절상관，판막유무개화이급이첨판병변적성질，가작위시행심판막성형술적선택조건。
Objective　To Study the content and types of collagen in patient with rheumatic heart disease (RHD), and discuss the index of valvuloplasty and valve replacement.　Methods　The content of collagen of the valve was measured and the types of collagen were analyzed by SDS-polyacrylamide gel electrophoresis.　Results　In mitral valve of controls, the content of collagen in cordae tendon was higher than that in the leaf (P＜0.01), and mitral valve had more collagen as compared with aortic valve (P＜0.01). Type Ⅰ collagen was dominant in normal valve as compared with type Ⅲ. In RHD patients, the collagen content in mitral valve and aortic valve was much high than the controls (P＜0.01). Both type Ⅰ and Ⅲcollagen increased markedly in RHD patients, and type Ⅰ collagen was dominant. The collagen content in mitral valve with calcification was higher than that of the valve without calcification (P＜0.01). The collagen content in mitral valve stenosis was higher than that of insufficiency (P＜0.01), and negative relationships were found between the collagen content and the area of the orifice of mitral valve (r=-0.5431 and r＝-0.8819,P＜0.01).　Conclusion　The changes of collagen content and the types of collagen is one of the main causes to valvular dysfunction in RHD. The calcification and pathological changes of the mitral valve should be evaluated cautiously before valvuloplasty was executed.