原位心脏移植对特发性扩张型心肌病结构微血管病变及异常血流动力学的影响。

Effects of orthotopic cardiac transplantation on structural microangiopathy and abnormal hemodynamics in idiopathic dilated cardiomyopathy.

作者信息

Wroblewski H, Sindrup J H, Nørgaard T, Haunsø S, Kastrup J

机构信息

Medical Department B 2142, Rigshospitalet, National University Hospital, University of Copenhagen, Denmark.

出版信息

Am J Cardiol. 1996 Feb 1;77(4):281-5. doi: 10.1016/s0002-9149(97)89394-0.

DOI:10.1016/s0002-9149(97)89394-0

PMID:8607409

Abstract

To examine whether cardiac transplantation would reverse morphologic and hemodynamic changes in peripheral circulation in idiopathic dilated cardiomyopathy, the structure of terminal arterioles and minimal vascular resistance were measured in skin at the dorsum of the foot in the same 14 patients before and 80 +/- 21 (mean +/- SD) days and 387 +/- 46 days after transplantation. The results were compared with data from a group of 16 healthy subjects. Blood flow was measured by the local technetium-99m pertechnetate washout method in a vascular bed relaxed with histamine. Structural microangiopathy (enhanced thickening of the basement membranes) in the arterioles was disclosed in skin biopsies in 11 of 14 patients before transplant, but in none of the 16 control subjects (p < 0.002). These abnormalities were unchanged 80 days after cardiac transplantation. However, arteriolar wall thickening was significantly reduced over the 1-year period after transplantation (p < 0.05), but this was not complete. Transplantation also led to a significant delayed decrease in minimal vascular resistance: before transplantation, 10.1 +/- 3.2 mm Hg.ml-1.100 g.min (mean +/- SD); 80 days after transplantation, 9.3 +/- 3.1 mm Hg.ml-1.100 g.min (p = NS), and 1 year after transplantation 7.6 +/- 2.4 mm Hg.ml-1 100 g.min (p < 0.01). Minimal vascular resistance before and 80 days after transplantation was significantly increased compared with that in healthy control subjects (6.3 +/- 1.7 mm Hg.ml-1 100g.min [p < 0.0003 and p < 0.003, respectively]). However, 1 year after transplantation, minimal vascular resistance was reduced to comparable levels when compared with that in control subjects (p = NS). These results indicate that structural microangiopathy and minimal vascular resistance in skin are improved slowly and gradually within the first year after orthotopic cardiac transplantation in patients with idiopathic dilated cardiomyopathy, however, the remodeling of histopathology is not accompanied by complete normalization.

摘要

为了研究心脏移植是否能逆转特发性扩张型心肌病患者外周循环的形态学和血流动力学变化，在同一组14例患者移植前、移植后80±21（均值±标准差）天以及387±46天，测量其足背皮肤终末小动脉的结构和最小血管阻力。将结果与16名健康受试者的数据进行比较。采用局部高锝酸盐99m洗脱法，在经组胺松弛的血管床中测量血流量。移植前14例患者中有11例皮肤活检显示小动脉存在结构性微血管病变（基底膜增厚增强），而16名对照受试者中均未发现（p<0.002）。心脏移植80天后，这些异常情况未改变。然而，移植后1年内小动脉壁增厚明显减轻（p<0.05），但并未完全恢复正常。移植还导致最小血管阻力显著延迟下降：移植前为10.1±3.2mmHg·ml-1·100g·min（均值±标准差）；移植后80天为9.3±3.1mmHg·ml-1·100g·min（p=无显著性差异），移植后1年为7.6±2.4mmHg·ml-1·100g·min（p<0.01）。移植前及移植后80天的最小血管阻力与健康对照受试者相比显著升高（分别为6.3±1.7mmHg·ml-1·100g·min，[p<0.0003和p<0.003]）。然而，移植后1年，与对照受试者相比，最小血管阻力降至相当水平（p=无显著性差异）。这些结果表明，特发性扩张型心肌病患者原位心脏移植后的第一年，皮肤结构性微血管病变和最小血管阻力缓慢且逐渐改善，然而，组织病理学重塑并未完全恢复正常。