Nakanishi Takaya, Kato Seiya
Department of Pathology and Cell Biology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan.
Department of Pathology and Cell Biology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan.
Pathol Res Pract. 2014 Dec;210(12):1018-25. doi: 10.1016/j.prp.2014.04.008. Epub 2014 Apr 23.
Lipid accumulation in the cardiac parenchyma has historically been known as fatty heart. Myocardial lipotoxicity and cardiac steatosis have been shown to be involved in the pathogenesis of obesity and diabetic mellitus (DM). Mutated adipose triglyceride lipase (ATGL), a key catalytic enzyme of triglyceride, has been found to cause human triglyceride deposit cardiomyovasculopathy (TGCV). Nevertheless, the significance of fatty heart in the disease process is still unclear. Here, we investigated myocardial lipid deposition (LD) in 73 autopsy cases. Nile blue staining revealed seven cases (9.5%) showing LD with elevated tissue triglyceride content, all of which suffered from DM. Immunohistochemically, ATGL expression was preserved in all tested cases. Rates of myocardial infarction and heart failure were higher in LD/DM cases than in non-LD cases. Semi-quantitative histological analysis revealed no significant differences in the degree of myocardial hypertrophy, myofibrillar loss, fibrosis, small vascular disease, inflammation or fat invasion between LD/DM and non-LD cases. However, more severe histological damage was seen in DM cases than in non-DM cases. Our data suggest that DM is a major risk for fatty heart with myocardial LD based on recent autopsy cases.
心脏实质中的脂质蓄积在历史上被称为脂肪心。心肌脂毒性和心脏脂肪变性已被证明与肥胖症和糖尿病（DM）的发病机制有关。已发现突变的脂肪甘油三酯脂肪酶（ATGL），一种甘油三酯的关键催化酶，可导致人类甘油三酯沉积性心血管病（TGCV）。然而，脂肪心在疾病过程中的意义仍不清楚。在此，我们对73例尸检病例的心肌脂质沉积（LD）进行了研究。尼罗蓝染色显示7例（9.5%）存在LD且组织甘油三酯含量升高，所有这些病例均患有DM。免疫组织化学分析显示，所有检测病例中ATGL表达均得以保留。LD/DM病例中心肌梗死和心力衰竭的发生率高于非LD病例。半定量组织学分析显示，LD/DM病例与非LD病例在心肌肥大程度、肌原纤维丧失、纤维化、小血管疾病、炎症或脂肪浸润方面无显著差异。然而，DM病例中的组织学损伤比非DM病例更严重。我们的数据表明，基于近期尸检病例，DM是发生伴有心肌LD的脂肪心的主要风险因素。
