CAJ | 학술논문

目的　探讨非创伤性监测及诊断心脏移植后急性移植物排斥反应(GR)方法。方法通过大鼠颈部心脏移植模型观察急性GR过程中移植心脏电生理改变，即房室传导有效不应期(ERP-AVCS)改变与移植心脏形态学改变的关系。结果　同系移植及异系移植免疫抑制剂投用组ERP-AVCS无延长；异系移植组移植后第3天，其 ERP-AVCS出现明显延长［(96.88±6.77) ms，P＜0.05］，第5天为(114.62±7.46 ) ms(P＜0.01)，第7天为(121.67±9.73) ms(P＜0.01)。同系移植及异系移植＋免疫抑制剂投用组形态学结构未见异常；异系移植组在移植后第3天开始出现急性GR，如心肌纤维间质明显增宽、排列紊乱，血管旁及间质内出现单核细胞等且第5天及第7天急性GR渐加重。异系移植心脏ERP-AVC与排斥反应形态学改变呈明显正相关(P＜0.01)。结论　检测移植心脏ERP-AVC是简便、可靠、低费用、非创伤性诊断移植心脏急性排斥反应手段。
목적　탐토비창상성감측급진단심장이식후급성이식물배척반응(GR)방법。방법통과대서경부심장이식모형관찰급성GR과정중이식심장전생리개변，즉방실전도유효불응기(ERP-AVCS)개변여이식심장형태학개변적관계。결과　동계이식급이계이식면역억제제투용조ERP-AVCS무연장；이계이식조이식후제3천，기 ERP-AVCS출현명현연장［(96.88±6.77) ms，P＜0.05］，제5천위(114.62±7.46 ) ms(P＜0.01)，제7천위(121.67±9.73) ms(P＜0.01)。동계이식급이계이식＋면역억제제투용조형태학결구미견이상；이계이식조재이식후제3천개시출현급성GR，여심기섬유간질명현증관、배렬문란，혈관방급간질내출현단핵세포등차제5천급제7천급성GR점가중。이계이식심장ERP-AVC여배척반응형태학개변정명현정상관(P＜0.01)。결론　검측이식심장ERP-AVC시간편、가고、저비용、비창상성진단이식심장급성배척반응수단。
Objective　To evaluate the correlation bet ween effective refractory period of atrioventricular conduction system (ERP-AVC S) and histopathological changes, to assess if ERP-AVCS could be a noninvasive procedure for frequently monitoring of acute heart graft rejection (GR). Methods　Three kinds of heterotopic neck heart transplants were performed. Group A: WKA rats received WKA rat isografts (n=32), group B: WKA rats received Fisher 344 allografts (n=30), and group C: WKA rats re ceived Fisher 344 allografts treated with immunosuppressants (n=32, 15-deox y spergualin 5 mg/kg and prednisolone 5 mg/kg per day after transplantation). The correlation between ERP-AVCS changes and the morphological changes in the graft s was observed during acute heart GR. Results　The ERP-AVCS in the groups A and C was not prolo n ged, while in the group B it was significantly prolonged from the day 3 to 7 aft er transplantation (96.88±6.77 ms at the day 3, P＜0.05; 114.62±7.46 ms at the day 5, P＜0.01; 121.67±9.73 ms at the day 7, P＜0.01). Histopathol ogically, no abnormalities occurred in the groups A and C, but in the group B, p rogressive moderate to severe GR occurred from the day 3 to 7 after transplantat ion. The correlation between the ERP-AVCS and histopathologic grade was particu larly notable in the group B (r=0.926, Y=9.00X+90.43, P＜0.01). Conclusion　Determination of ERP-AVCS is a promising simple noninvasive procedure for detecting acute heart GR.