Takagi T, Okada R
Am Heart J. 1980 Dec;100(6 Pt 1):838-46. doi: 10.1016/0002-8703(80)90064-2.
We performed an electrocardiographic-pathologic correlative study using the step sectioning method in 35 autopsy specimens from patients with hypertension. Eleven out of 12 cases (91.7%) in Group 1 had severe lesions at LBBa or the His bundle and we propose that LAD in excess of -30 degrees is a good criterion in hypertension for LAH. There were six cases in all with severe lesions at both radiations of the LBB. In one case of Group 1, LAD is suggested to be due to slower conduction at the LBBa than at the LBBp and findings in five cases of Groups 2 and 3 led us to speculate that there was no LAD because of cancellation between the LBBa and the LBBp. Histopathology revealed fibrosis, degeneration, bleeding, and calcification which pathogenetically may derive from mechanical strain effected by hypertension, and metabolic changes in cases with chronic renal failure.
我们采用阶梯切片法对35例高血压患者的尸检标本进行了心电图-病理相关性研究。第1组12例中有11例（91.7%）在左束支前分支（LBBa）或希氏束有严重病变，我们提出，在高血压患者中，额面QRS电轴（LAD）超过-30度是左前分支阻滞（LAH）的良好标准。总共有6例在左束支的两个分支均有严重病变。第1组中有1例提示LAD是由于LBBa的传导比左束支后分支（LBBp）慢，第2组和第3组中5例的结果使我们推测，由于LBBa和LBBp之间的抵消作用而不存在LAD。组织病理学显示有纤维化、变性、出血和钙化，从发病机制来看，这些可能源于高血压引起的机械性应变以及慢性肾衰竭病例中的代谢变化。
