窦房结异常与心肌梗死的相关性

发布时间：2018-05-11 01:29

  本文选题：冠状动脉粥样硬化 + 窦房结　； 参考：《青岛大学》2017年硕士论文

【摘要】：目的探讨窦房结(sinoatrial node,SAN)间质增生和超极化激活环核苷酸门控阳离子通道基因4(hyperpolarization activated cyclic nucleotide gated cation channel 4,HCN4)的表达与心肌梗死(myocardial infarction,MI)的关系,及其与左右冠状动脉粥样硬化管腔狭窄程度、年龄、性别等临床病理学特征的关系,以分析心肌梗死是否影响窦房结间质增生和HCN4的表达,并进一步研究心肌梗死透壁程度、窦房结间质增生和HCN4表达的相关性。方法收集35例非心肌梗死和13例心肌梗死尸体解剖心脏标本,记录死者死亡原因、年龄、性别。肉眼观察左右冠状动脉狭窄和心肌梗死情况,分别对窦房结和左右冠状动脉(狭窄最严重处)进行取材;对于心肌梗死者,一并在其左心室各壁(包括室间隔和心尖)梗死透壁程度最严重处取材。常规制片。左右冠状动脉进行HE染色;各心室壁进行HE染色、苦味酸染色;窦房结进行HE染色、Masson染色。从35例非心肌梗死案例中选取13例与13例心肌梗死者的窦房结进行HCN4免疫组织化学染色(由HE染色、Masson染色后选定位置)。北京Tissue Gnostics China Division公司组织图像分析系统、Image pro plus 6.0图像分析系统和本中心法医病理医师肉眼及镜下观察分析相结合统计窦房结间质增生程度、HCN4表达情况、左右冠状动脉相对狭窄程度和心肌梗死透壁程度。采用等级logistic回归、多元线性回归、Spearman相关和Mann-Whitney U秩和检验进行统计学分析。结果本实验发现窦房结主要病理形态学改变为间质增生,即纤维化和脂肪浸润,心肌梗死患者窦房结间质增生程度绝大部分达Ⅱ~Ⅲ级,其内P细胞数量减少。窦房结间质增生与左右冠状动脉粥样硬化管腔狭窄程度和年龄有关(P0.05),而与性别和心肌梗死可能无直接相关性(P0.05)。HCN4在窦房结内非均质的表达在细胞质及细胞膜上,但主要表达在细胞膜;HCN4的表达与右冠状动脉供血减少有关(P0.05)。心肌梗死者左右冠状动脉粥样硬化与窦房结间质增生的多元线性回归方程:Y=3.885+0.462X1+0.380X2,决定系数R2=0.688,P=0.003。针对每一个体而言,心肌梗死透壁程度与窦房结间质增生呈正相关(rs=0.608,P=0.028),与HCN4的表达无直接相关性(P=0.871);窦房结间质增生与HCN4的表达也无直接相关性(P=0.808)。MI组与非MI组窦房结HCN4的表达无统计学差异(P=0.724)。结论左右冠状动脉粥样硬化管腔狭窄、年龄均可影响窦房结间质增生,右冠状动脉粥样硬化管腔狭窄可以影响窦房结HCN4的表达。对心肌梗死患者,窦房结间质增生与血供减少密切相关。尸检心肌梗死透壁程度与窦房结间质增生呈同向发展,但与HCN4的表达并不相关。窦房结间质增生可能是心肌梗死引起心源性猝死的一个重要原因。
[Abstract]:Objective to investigate the relationship between interstitial hyperplasia and hyperpolarization-activated cyclic nucleotide-gated cationic channel gene 4(hyperpolarization activated cyclic nucleotide gated cation channel _ 4 (HCN4) and myocardial infarction (myocardial infarction) in sinoatrial node (San), and its relationship with stenosis degree and age of left and right coronary atherosclerotic arteries. The relationship between sex and other clinicopathological features in order to analyze whether myocardial infarction affects sinoatrial node interstitial hyperplasia and HCN4 expression, and to further study the correlation between myocardial infarction transmural degree, sinus node interstitial hyperplasia and HCN4 expression. Methods 35 non-myocardial infarction and 13 myocardial infarction cadaveric heart specimens were collected to record the cause of death, age and sex. The left and right coronary artery stenosis and myocardial infarction were observed with the naked eye. The sinus node and the left and right coronary arteries (where the stenosis was most serious) were taken, respectively. At the same time, the most severe transmural infarction of the left ventricular wall (including septum and apical) was obtained. Conventional production. The left and right coronary arteries were stained with HE, each ventricular wall was stained with HE, picric acid was stained, and sinoatrial node was stained by HE staining and Masson staining. The sinoatrial node of 13 cases and 13 cases of myocardial infarction were selected from 35 cases of non-myocardial infarction. The sinoatrial node was stained by HCN4 immunohistochemical staining (selected location by HE staining and Masson staining). The image pro plus 6.0 image analysis system of Beijing Tissue Gnostics China Division Company combined with the naked eye and microscopic observation and analysis of the forensic pathologist of our center analyzed the expression of HCN4 in sinoatrial node stromal hyperplasia. Relative stenosis of left and right coronary artery and transmural myocardial infarction. Grade logistic regression, multivariate linear regression and Mann-Whitney U rank sum test were used to analyze statistical data. Results the main pathomorphological changes of sinoatrial node were interstitial hyperplasia, I. E. fibrosis and fat infiltration. The degree of interstitial hyperplasia of sinoatrial node in patients with myocardial infarction was mostly grade 鈪，

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