心脏结节病:被遗忘的肉芽肿病的当代概念
Cardiac Sarcoidosis: A Contemporary Concept of Forgotten Granulomatosis.
作者信息
Avagimyan Ashot, Mkrtchyan Lusine, Bairamyan Tamara, Jndoyan Zinaida, Navasardyan Grizelda, Ginosyan Knarik, Aznauryan Anahit, Sahakyan Karmen, Ionov Alexey, Pavluchenko Ivan, Gogiashvili Liana, Shafie Davood, Sarrafzadegan Nizal
机构信息
Department of Anatomical Pathology and Clinical Morphology, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia.
Department of Cardiology, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia.
出版信息
ARYA Atheroscler. 2023 Sep-Oct;19(5):52-62. doi: 10.48305/arya.2023.41534.2888.
Sarcoidosis is a complex multisystem inflammatory granulomatous disease that can affect any organ, with a wide range of clinical presentations. A significant number of patients with systemic sarcoidosis may also have cardiac involvement. Clinical manifestations of cardiac sarcoidosis can include various rhythm and conduction disturbances, as well as heart failure. The structure of sarcoid granulomas is similar to that of tuberculous granulomas, but in contrast, they lack caseous necrosis. Tissue changes in sarcoidosis tissues depend on the stage of development of the disease, progressing from pathological process: macrophage-lymphocytic infiltration to epithelioid cell granuloma formation, and fibrosis. Granulomas can be found in any part of the myocardium, with the most common locations being the free wall of the left ventricle, the basal part of the interventricular septum, and the interatrial septum. Vasculopathy of the pulmonary circulation and coronary arteries is often observed. Advancements in diagnostic imaging techniques, such as computer tomography and magnetic resonance imaging, have facilitated the verification of cardiac sarcoidosis. This article presents an analysis of updated information on cardiac sarcoidosis by a multidisciplinary working group.
结节病是一种复杂的多系统炎症性肉芽肿疾病,可累及任何器官,临床表现多种多样。相当一部分系统性结节病患者也可能有心脏受累。心脏结节病的临床表现可包括各种节律和传导紊乱以及心力衰竭。结节病肉芽肿的结构与结核性肉芽肿相似,但与之不同的是,它们缺乏干酪样坏死。结节病组织的组织学变化取决于疾病的发展阶段,从病理过程来看,是从巨噬细胞-淋巴细胞浸润发展到上皮样细胞肉芽肿形成,再到纤维化。肉芽肿可出现在心肌的任何部位,最常见的部位是左心室游离壁、室间隔基部和房间隔。肺循环和冠状动脉的血管病变也经常可见。计算机断层扫描和磁共振成像等诊断成像技术的进步有助于心脏结节病的确诊。本文展示了一个多学科工作组对心脏结节病最新信息的分析。