CAJ | 학술논문

目的：探讨限制型心肌病患者心内膜心肌活检的组织学病理特点以及相关心功能变化。方法对我院急诊科2010年1月至2013年10月收治的40例限制型心肌病患者(心肌病组)进行心内膜心肌活检，并做实验室检查、右心导管以及心肌病理检查，对其结果进行分析，并与40例正常对照组比较。结果心肌病组的B型利钠肽(BNP)、肌酸激酶同工酶(CK-MB)和肌钙蛋白I (TnI)明显高于对照组(P均<0.05)；心肌病组的右心房压、右心室收缩压、右心室舒张末压和肺动脉楔压明显高于对照组[右心房压：(18.7±4.5) mmHg vs (10.2±1.4) mmHg；右心室收缩压：(46.5±5.6) mmHg vs (34.7±3.7) mmHg；右心室舒张末压：(16.3±4.6)mmHg vs (8.6±2.6) mmHg；肺动脉楔压：(28.6±5.3) mmHg vs (14.2±3.8) mmHg，P均<0.05]；20例诊断为心肌淀粉样变性，6例诊断为嗜酸性粒细胞增多综合征累及心肌，14例心内膜心肌活检提示存在心肌病变。结论淀粉样变性、嗜酸性粒细胞浸润和特发性心肌病是限制型心肌病的主要病因。心内膜心肌活检对于限制型心肌病的病因诊断意义重大。
목적：탐토한제형심기병환자심내막심기활검적조직학병리특점이급상관심공능변화。방법대아원급진과2010년1월지2013년10월수치적40례한제형심기병환자(심기병조)진행심내막심기활검，병주실험실검사、우심도관이급심기병리검사，대기결과진행분석，병여40례정상대조조비교。결과심기병조적B형리납태(BNP)、기산격매동공매(CK-MB)화기개단백I (TnI)명현고우대조조(P균<0.05)；심기병조적우심방압、우심실수축압、우심실서장말압화폐동맥설압명현고우대조조[우심방압：(18.7±4.5) mmHg vs (10.2±1.4) mmHg；우심실수축압：(46.5±5.6) mmHg vs (34.7±3.7) mmHg；우심실서장말압：(16.3±4.6)mmHg vs (8.6±2.6) mmHg；폐동맥설압：(28.6±5.3) mmHg vs (14.2±3.8) mmHg，P균<0.05]；20례진단위심기정분양변성，6례진단위기산성립세포증다종합정루급심기，14례심내막심기활검제시존재심기병변。결론정분양변성、기산성립세포침윤화특발성심기병시한제형심기병적주요병인。심내막심기활검대우한제형심기병적병인진단의의중대。
Objective To explore the histological and pathological features of restrictive cardiomyopathy by endomyocardial biopsy, as well as cardiac function changes. Methods From January 2010 to October 2013, 40 pa-tients of restrictive cardiomyopathy from the Emergency Department (cardiomyopathy group) were treated by endo-myocardial biopsy, laboratory tests, right heart catheterization and cardiac pathology. The results were analyzed and compared with that of 40 healthy individuals (the control group). Results The levels of B-type natriuretic peptide (BNP), CK-MB and TnI of cardiomyopathy group were significantly higher than those of the control group (P<0.05);The right atrial pressure, right ventricular systolic pressure, right ventricular end-diastolic pressure and pulmonary ar-tery wedge pressure of cardiomyopathy group were significantly higher than the control group: right atrial pressure:(18.7 ± 4.5) mmHg vs (10.2 ± 1.4) mmHg;right ventricular systolic pressure:(46.5 ± 5.6) mmHg vs (34.7 ± 3.7) mmHg;right ventricular end-diastolic pressure (16.3±4.6) mmHg vs (8.6±2.6) mmHg;pulmonary artery wedge pressure (28.6± 5.3) mmHg vs (14.2±3.8) mmHg, all with P<0.05. Twenty patients were diagnosed as cardiac amyloidosis, 6 were di-agnosed as eosinophilic increased syndrome involving myocardium, and 14 suggested the presence of myocardium dis-ease. Conclusion Amyloidosis, eosinophil infiltration and idiopathic cardiomyopathy are major causes of restrictive cardiomyopathy. Endomyocardial biopsy has great significance for the diagnosis of restrictive cardiomyopathy.