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背景:心脏间质主要由Ⅰ,Ⅲ型胶原组成,对心肌细胞起支持、保护和制约的作用,是维持心脏正常的形态和功能不可缺少的成分。目的:观察室间隔缺损儿童心房Ⅰ型和Ⅲ型胶原蛋白表达的变化,探讨其对心功能的影响。设计:病例分析。单位:新乡医学院细胞生物学教研室。对象:选择2003-01/08新乡医学院第一附属医院儿科6例事故死亡的儿童,家属知情同意,男4例,女2例;年龄1～15岁,大体解剖证明无先天性心脏病,取右心房组织。同期选择新乡医学院第一附属医院心胸外科21例室间隔缺损患儿,男12例,女9例;年龄1～17岁。方法:从右心房手术切缘处取少许新鲜组织。采用过氧化物酶标记的链霉卵白素免疫组化观察心脏胶原Ⅰ型和Ⅲ型蛋白表达,用数字图像分析方法测量心脏胶原Ⅰ型和Ⅲ型蛋白面积构成比(代表胶原蛋白表达的相对面积含量),面积百分比(代表胶原蛋白表达的百分含量)。主要观察指标:心房肌细胞Ⅰ,Ⅲ型胶原蛋白表达。结果:6例死亡儿童和21例室间隔缺损患儿的心房组织均进入结果分析。①正常心房Ⅰ型胶原为粗、细不等的条状纤维,彼此连接成网;Ⅲ型胶原纤维呈散在的斑片状分布。②室间隔缺损心房Ⅰ和Ⅲ型胶原表达,大多区域属于正常。仅部分区域发生极度重排,即Ⅰ型胶原呈现大斑块状增加、断裂或消失,Ⅲ型胶原呈条束状增加。③Ⅰ型和Ⅲ型胶原面积百分比和面积构成比:正常心肌Ⅰ型胶原含量较Ⅲ型胶原多犤面积百分比:(48.82±12.35)%,(40.02±13.53)%,t=2.173,P<0.05;面积构成比(15.87±6.03)μm2,(13.62±6.94)μm2,t=2.221,P<0.05犦。室间隔缺损儿童心肌Ⅰ型胶原含量较Ⅲ型胶原多犤面积百分比:(55.37±10.42)%(50.27±14.36)%,t=2.173,P<0.05;面积构成比(24.93±9.62)μm2(19.22±12.03)μm2,t=2.221,P<0.05犦。室间隔缺损儿童心肌Ⅰ型,Ⅲ型胶原含量较正常心肌明显增多(t=2.153～2.234,P<0.05)。结论:室间隔缺损儿童心房部分区域Ⅰ和Ⅲ型胶原纤维形态上出现重构,含量增加,可能是室间隔缺损儿童心功能异常出现的心脏间质代偿。
Background: The cardiac interstitial tissue mainly consists of type I and type III collagen, which plays a supporting, protecting and restricting role in cardiomyocytes. It is an indispensable component for maintaining the normal morphology and function of the heart. Objective: To observe the changes of atrial collagen type Ⅰ and Ⅲ in children with ventricular septal defect and to explore its influence on cardiac function. Design: Case Analysis. Unit: Department of Cell Biology, Xinxiang Medical College. PARTICIPANTS: Children with 6 deaths from pediatric department of First Affiliated Hospital of Xinxiang Medical College from January 2003 to December 2003 were informed by their family members. There were 4 males and 2 females, aged from 1 to 15 years old. The general anatomy showed no congenital heart disease, Right atrial tissue. In the same period, 21 cases of ventricular septal defect were selected from the Department of Cardiothoracic Surgery, the First Affiliated Hospital of Xinxiang Medical College. There were 12 males and 9 females, aged from 1 to 17 years old. Method: Take a little fresh tissue from the right atrial surgery margin. Peroxidase-labeled streptavidin immunohistochemistry was used to observe the expression of cardiac collagen type I and type III proteins. The digital image analysis method was used to measure the ratio of the area ratio of collagen type I and type III collagen (representing the relative area of collagen protein expression Content), area percentage (representing the percentage of collagen expression). MAIN OUTCOME MEASURES: Expression of type Ⅰ and Ⅲ collagen in atrial myocytes. Results: Atrial tissues of 6 children and 21 children with ventricular septal defect were involved in the result analysis. ① normal atrial collagen type Ⅰ is coarse, thin strip of fibers ranging from each other, connected to form a network; type Ⅲ collagen fibers were scattered patch-like distribution. ② ventricular septal defect type Ⅰ and type Ⅲ collagen expression, most of the area is normal. Only a part of the area of extreme rearrangement, that type Ⅰ collagen showed a large plaque increased, ruptured or disappeared, type Ⅲ collagen in a bundle-like increase. The percentage of area and ratio of type Ⅰ and type Ⅲ collagen: the area percentage of type Ⅰ collagen in normal myocardium was (48.82 ± 12.35)%, (40.02 ± 13.53)%, t = 2.173, P <0.05; The area ratio (15.87 ± 6.03) μm2, (13.62 ± 6.94) μm2, t = 2.221, P <0.05 犦. The percentage of collagen type Ⅰ collagen in type Ⅰ ventricular septal defect was (55.37 ± 10.42)% (50.27 ± 14.36)%, t = 2.173, P <0.05, and the area ratio was 24.93 ± 9.62 μm2 (19.22 ± 12.03) μm 2, t = 2.221, P <0.05 犦. The levels of type Ⅰ and type Ⅲ collagen in children with ventricular septal defect were significantly higher than those in normal myocardium (t = 2.153-2.234, P <0.05). CONCLUSION: The type I and type III collagen fibers in atrial septal defect in children with ventricular septal defect are remodeled and increased in content, which may be the result of cardiac interstitial compensation in children with ventricular septal defect.