Horike K, Fujiwara H, Matsuda M, Kawamura A, Ishida M, Takemura G, Kida M, Uegaito T, Tanaka M, Matsumori A
Department of Internal Medicine, Faculty of Medicine, Kyoto University, Japan.
Jpn Circ J. 1991 Jan;55(1):24-32. doi: 10.1253/jcj.55.24.
To investigate the mechanism of cardiac dysfunction in myocarditis, myoglobin, an intracellular oxygen-transport, was immunohistochemically examined in biopsy specimens obtained from the right side of the ventricular septum and left ventricular free wall in 58 patients with myocarditis and 19 controls. Sections 4 microns thick were stained by the indirect immunoperoxidase method using a polyclonal antibody to human myoglobin as the primary antibody. Under light microscopy, the intensity of myoglobin immunoreactivity in the tissue section was semiquantitatively classified from grade 0 to grade 3. Then, the grade of myoglobin staining was compared with clinical, hemodynamic and histopathologic parameters. In right and left ventricular specimens, the grade of myoglobin staining was positively correlated with ejection fraction, but inversely with left ventricular end-diastolic and end-systolic volume indices. The percentage of myocytes with grade 0 was correlated with the number of mononuclear cells in the specimens. In addition, the grade of myoglobin staining in right ventricular specimens was positively correlated with the duration of illness but inversely correlated with the number of mononuclear cells. In 4 patients who had serial biopsies, the ejection fraction was improved and the grade of myoglobin staining was increased in the convalescent stage. These results indicate that myoglobin staining reflects the intensity of myocarditis and a decrease of myoglobin may be important as one of the pathogenetic factors of cardiac dysfunction in myocarditis.
为研究心肌炎中心脏功能障碍的机制，对58例心肌炎患者及19例对照者取自室间隔右侧和左心室游离壁的活检标本进行免疫组织化学检查，检测细胞内氧转运蛋白肌红蛋白。将4微米厚的切片用抗人肌红蛋白多克隆抗体作为一抗，采用间接免疫过氧化物酶法染色。在光学显微镜下，将组织切片中肌红蛋白免疫反应强度进行半定量分级，从0级到3级。然后，将肌红蛋白染色分级与临床、血流动力学及组织病理学参数进行比较。在右心室和左心室标本中，肌红蛋白染色分级与射血分数呈正相关，但与左心室舒张末期和收缩末期容积指数呈负相关。0级肌细胞百分比与标本中单核细胞数量相关。此外，右心室标本中肌红蛋白染色分级与病程呈正相关，但与单核细胞数量呈负相关。在4例接受系列活检的患者中，恢复期射血分数改善，肌红蛋白染色分级增加。这些结果表明，肌红蛋白染色反映心肌炎的严重程度，肌红蛋白减少可能是心肌炎心脏功能障碍发病机制的重要因素之一。
