Barretto A C, Higuchi M L, da Luz P L, Lopes E A, Bellotti G, Mady C, Stolf N, Arteaga-Fernández E, Pileggi F
Arq Bras Cardiol. 1989 Feb;52(2):79-83.
In this study the histopathologic features of Chagas' disease and idiopathic dilated cardiomyopathy were compared in 38 patients with congestive heart failure, classes II or III. Biopsy specimens were obtained with the Stanford model needle for right ventricle. Twenty-two patients presented non-chagasic dilated cardiomyopathy, and 16 were carriers of Chagas' disease. Twenty-three were male and 15 were female; their ages varied 18 and 49 years (mean 35.5). Fibrosis was slightly more frequently and intense in Chagas' disease than in dilated cardiomyopathy. Myocarditis aspect also was more frequent in Chagas' disease than in dilated cardiomyopathy (62.4% vs. 50%), with all cases showing a chronic form; acute myocarditis was observed only in dilated myocardiopathy. These differences, however, did not reach statistical significance. In conclusion, the presence of fibrosis, hypertrophy and moderate to severe degrees of chronic inflammatory infiltrate are suggestive of but not pathognomonic of Chagas' disease. On the other hand, dilated myocardiopathies are more frequently associated with less fibrosis or hypertrophy and the presence of mild degree of inflammatory infiltrate. The arrangement of this inflammatory infiltrate tends to be diffuse in dilated cardiomyopathy and in chagasic myocarditis it is multifocal, very similar to the histopathological aspect found in myocardial rejections episodes of transplanted hearts.
在本研究中，对38例II级或III级充血性心力衰竭患者的恰加斯病和特发性扩张型心肌病的组织病理学特征进行了比较。使用斯坦福模型针获取右心室活检标本。22例患者表现为非恰加斯性扩张型心肌病，16例为恰加斯病携带者。23例为男性，15例为女性；年龄在18至49岁之间（平均35.5岁）。恰加斯病中的纤维化比扩张型心肌病更频繁且更严重。恰加斯病中心肌炎表现也比扩张型心肌病更常见（62.4%对50%），所有病例均为慢性形式；仅在扩张型心肌病中观察到急性心肌炎。然而，这些差异未达到统计学意义。总之，纤维化、肥大以及中度至重度慢性炎症浸润的存在提示但并非恰加斯病的特征性表现。另一方面，扩张型心肌病更常伴有较少的纤维化或肥大以及轻度炎症浸润。这种炎症浸润在扩张型心肌病中倾向于弥漫性分布，而在恰加斯性心肌炎中则为多灶性，与移植心脏心肌排斥反应发作时的组织病理学表现非常相似。
