Frederiks W M, Tukkie R, Gründeman P F, Hoebe C, Schellens J P
Academic Medical Center, University of Amsterdam, The Netherlands.
J Pathol. 1995 Mar;175(3):339-48. doi: 10.1002/path.1711750312.
In cardiac surgery, recognition of peroperative myocardial infarction may improve patient selection for prolonged circulatory support. The value of enzyme histochemistry to discriminate between reversible and irreversible myocardial damage at short periods of reperfusion was studied in an in vivo model of regional ischaemia in pig hearts. The left anterior descending coronary artery (LADCA) was clamped for 45 min followed by 2 h reperfusion (group 1, n = 3). Post-mortem heart tissue showed markedly decreased activities of lactate dehydrogenase (LDH) and beta-hydroxybutyrate dehydrogenase (BDH) as demonstrated in cryostat sections, accompanied by massive leakage of LDH in the venous effluent. The depleted areas showed irreversible cell damage based on the presence of flocculent densities in mitochondria. In group 2 (n = 6), LADCA flow was reduced to 40 per cent of the base-line value followed by 2 h reperfusion. Heart tissue showed normal LDH and BDH activities, except for some cells surrounding blood vessels, which activity was minimally decreased. Flocculent densities in mitochondria were never observed. We conclude that enzyme histochemistry of LDH and BDH activity on cryostat sections is a useful tool for detecting irreversible myocardial cell damage as early as 2 h reperfusion after ischaemia of the pig heart. The technique has potential applications in the detection of peroperative infarction in human biopsies.
在心脏外科手术中，识别围手术期心肌梗死可能会改善对延长循环支持的患者选择。在猪心脏局部缺血的体内模型中，研究了酶组织化学在短时间再灌注时区分可逆性和不可逆性心肌损伤的价值。左冠状动脉前降支（LADCA）夹闭45分钟，随后再灌注2小时（第1组，n = 3）。尸检心脏组织显示，在低温切片中乳酸脱氢酶（LDH）和β-羟丁酸脱氢酶（BDH）的活性显著降低，同时静脉流出物中LDH大量泄漏。基于线粒体中存在絮状密度，耗尽区域显示出不可逆的细胞损伤。在第2组（n = 6）中，LADCA血流降至基线值的40%，随后再灌注2小时。心脏组织显示LDH和BDH活性正常，除了血管周围的一些细胞，其活性略有降低。从未观察到线粒体中的絮状密度。我们得出结论，低温切片上LDH和BDH活性的酶组织化学是在猪心脏缺血后再灌注2小时时检测不可逆心肌细胞损伤的有用工具。该技术在检测人类活检组织中的围手术期梗死方面具有潜在应用价值。
