神经性心肌病与心肌冬眠

V. Volkov
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摘要

目的:对已有的资料进行总结和新的解释,以证明抗精神病性心肌病(NCMP)患者心肌冬眠的发生。方法与结果:采用符合现代循证医学要求的形态计量学方法进行研究。所研究的微形态测量参数描述了心肌的三个结构成分(血管、细胞间基质和实质)的状况。计算毛细血管周围弥散区(ZPD)、Kernogan指数(KI)、SPR、RIE等参数。对心肌细胞(CMCs)进行核术和细胞术检测,测定肥大心肌细胞(SVHC)和萎缩心肌细胞(SVAC)的比体积,并通过偏振显微镜法测定营养不良心肌细胞(SVDC)的比体积。当NCMP缺失时,SCD和NMS的变化具有急性特征,反映了各自定量参数的统计学显著变化。当NCMP存在时,唯一在与SCD和NMS的连接中发生显著变化的参数是SVDC。结论:NCMP对心肌造成不可逆的损伤,导致其活性降低,几乎完全阻止其对任何影响的反应,特别是对SCD的到来和NMS的发展。在NCMP病例中发现的心肌形态功能状态是NCMP在形态发生过程中出现的HM状态的独立证明。
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Neuroleptic Cardiomyopathy and MyocardialHibernation
Aim: It is to summarize and in a new way to interpret the data, which have been earlier received, in order to prove the development of the hibernation of myocardium (HM) in cases of the neuroleptic cardiomyopathy (NCMP). Methods and results: Morphometric methods of research were used which meet modern requirements of the evidence-based medicine. The studied micro morphometric parameters describe the condition of three structural components of myocardium (vasculature, intercellular matrix, and parenchyma). Such parameters as zone of pericapillary diffusion (ZPD), Kernogan index (KI), SPR, RIE were calculated. Karyometry and cytometry of cardiomyocytes (CMCs) were performed, the specific volumes of hypertrophied CMCs (SVHC), of atrophied ones (SVAC), and – by the method of polarization microscopy – the specific volume of dystrophic ones (SVDC) were determined. When NCMP is absent, the changes, which have an acute character, develop in the case of SCD and NMS and reflect the statistically significant shifts of the respective quantitative parameters. When NCMP is present, the only parameter, which is significantly changed in connection with SCD and NMS, is SVDC. Conclusion: NCMP causes irreversible damages in myocardium, it leads to its are activity, practically almost fully prevents it from reacting to any influences, particularly to the coming of SCD and/or development of NMS. The found morpho functional state of cardiac muscle in the case of NCMP is an independent proof of state of HM which appears during the process of morphogenesis of NCMP.
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