Kolbeck P C, Steenbergen C, Wolfe J A, Sanfilippo F, Jennings R B
Pathology Department, Duke University Medical Center, Durham, North Carolina 27110.
Am J Clin Pathol. 1989 Jan;91(1):37-44. doi: 10.1093/ajcp/91.1.37.
Endomyocardial biopsy specimens from 96 patients with unexplained congestive heart failure or dysrhythmia were evaluated by standard histologic techniques and by direct immunofluorescence and immunoperoxidase cell marker analysis for mononuclear cell infiltration. Control specimens derived from normal autopsy hearts (n = 8) and autopsy hearts with severe coronary artery disease (n = 9) were analyzed in a similar fashion. The results were correlated with functional data obtained from cardiac catheterizations as well as the clinical history. The objectives of the study were to assess the sensitivity and specificity of immunoperoxidase identification of lymphocytes for the diagnosis of myocarditis and to correlate clinical parameters such as degree of cardiac dysfunction and symptom duration with the extent of inflammatory changes. No control biopsies (neither normal nor ischemic) had a T-cell concentration of one or more cells per high-power field (HPF:200X), whereas 32% of the study cases had more than one T-cell per HPF. Heavy T-cell infiltration (greater than or equal to 3 per HPF) was present in 7% of the study cases and occurred most commonly when the symptoms were of recent onset. The results demonstrate that lymphocytes are not present (less than 1 per HPF) in normal myocardium, in viable myocardium from hearts with generalized coronary artery disease, and in most endomyocardial biopsies (68%) from patients with unexplained heart failure or dysrhythmia. Thus, lymphocyte infiltration is not a nonspecific response to cardiac dysfunction. Immunoperoxidase identification of lymphocytes provides a quantitative assessment of inflammatory cell infiltration that is useful in the detection of myocarditis.
对96例不明原因的充血性心力衰竭或心律失常患者的心肌内膜活检标本，采用标准组织学技术、直接免疫荧光法和免疫过氧化物酶细胞标志物分析法评估单核细胞浸润情况。以类似方式分析了取自正常尸检心脏（n = 8）和患有严重冠状动脉疾病的尸检心脏（n = 9）的对照标本。将结果与从心导管检查获得的功能数据以及临床病史相关联。本研究的目的是评估免疫过氧化物酶鉴定淋巴细胞对心肌炎诊断的敏感性和特异性，并将心脏功能障碍程度和症状持续时间等临床参数与炎症变化程度相关联。对照活检标本（正常或缺血性）在高倍视野（HPF:200X）下均未发现每视野有一个或更多个T细胞，而研究病例中有32%每HPF有一个以上T细胞。7%的研究病例存在重度T细胞浸润（每HPF大于或等于3个），最常见于症状近期发作时。结果表明，正常心肌、患有广泛性冠状动脉疾病心脏的存活心肌以及大多数不明原因心力衰竭或心律失常患者的心肌内膜活检标本（68%）中不存在淋巴细胞（每HPF少于1个）。因此，淋巴细胞浸润并非对心脏功能障碍的非特异性反应。免疫过氧化物酶鉴定淋巴细胞可对炎症细胞浸润进行定量评估，这对心肌炎的检测很有用。
