Wang D R
Department of Pathology, General Hospital of Xizang Command, Lasa.
Zhonghua Bing Li Xue Za Zhi. 1992 Oct;21(5):302-4.
This paper reports the histopathologic and ultrastructural changes in 37 children and 20 adults with high altitude heart disease. Its clinicopathologic features, diagnostic criteria and differential diagnosis from Ke-shan disease and other heart diseases are discussed. The right heart of 37 children showed hypertrophy and dilatation. Microscopically, necrosis and scarring were found mainly in the right ventricular wall (29/37) and the anterior papillary muscles (29/37) of the right ventricle. The hearts of 20 adults (19 Hans and 1 Tibetan) were enlarged and increased in weight. Heart weight increased to 400-500g in 15 cases, and hypertrophy of both ventricles was seen in 16 cases. Necrosis and scarring were found mainly in the papillary muscles (20:16) and the ventricular walls (11:19) of the left and right ventricles. Electronmicroscopy showed that myofibrils were dissolved or degenerated, mitochondria swelled, endoplasmic reticula dilated and glycogen granules decreased. As regards the pathogenesis, the authors stress the role of chronic hypoxia which causes myocardial damage, and advocate the importance of early diagnosis and treatment.
本文报告了37例儿童和20例成人高原性心脏病的组织病理学和超微结构变化。讨论了其临床病理特征、诊断标准以及与克山病和其他心脏病的鉴别诊断。37例儿童的右心表现为肥厚和扩张。显微镜下，坏死和瘢痕形成主要见于右心室壁（29/37）和右心室前乳头肌（29/37）。20例成人（19例汉族和1例藏族）的心脏增大、重量增加。15例心脏重量增加至400 - 500克，16例可见双心室肥厚。坏死和瘢痕形成主要见于左、右心室的乳头肌（20:16）和心室壁（11:19）。电镜显示肌原纤维溶解或变性、线粒体肿胀、内质网扩张和糖原颗粒减少。关于发病机制，作者强调慢性缺氧导致心肌损伤的作用，并提倡早期诊断和治疗的重要性。
