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目的 探讨严重急性呼吸综合征(SARS)对心脏、尤其是心脏传导系统的影响。方法 应用HE、组织化学及核酸原位杂交等方法 ,对 6例SARS死亡患者的心脏组织及其中 1例死者的心脏传导系统进行病理研究。结果 SARS患者的心脏损伤表现为心肌细胞空泡变性、萎缩和少数心肌细胞肌浆溶解 ,心肌间质轻度水肿、少量炎细胞浸润及轻度小血管炎 ;Macchiavello染色示心肌细胞胞质内偶见病毒包涵体 ;核酸原位杂交示少部分心肌细胞及心脏传导系统特化心肌细胞内呈现明确的冠状病毒 (SARS CoV)阳性杂交信号。结论 SARS CoV不仅能够感染心肌细胞 ,而且可感染心脏传导系统中的特化心肌细胞 ,可引起心脏轻度病毒性心肌炎性改变。该研究结果为解释临床上SARS患者心律失常和心肌酶谱异常提供了重要的病理学依据。
Objective To investigate the effects of severe acute respiratory syndrome (SARS) on the heart, especially the cardiac conduction system. Methods HE, histochemistry and in situ hybridization were used to investigate the pathology of heart conduction in 6 SARS patients and 1 deceased heart. Results The cardiac injury in SARS patients showed vacuolar degeneration and atrophy of cardiomyocytes, sarcoplasmic lysis of a few cardiomyocytes, mild edema of myocardial interstitium, infiltration of a few inflammatory cells and mild vasculitis. Macchiavello staining showed that intracytoplasmic even See the virus inclusion body; in situ hybridization showed that a few positive cardiomyocytes (SARS CoV) positive hybridization signals were found in a few cardiac myocytes and cardiomyocytes. Conclusion SARS CoV not only can infect myocytes, but also can infect specialized cardiomyocytes in cardiac conduction system, which can cause mild viral myocarditis in the heart. The results provide an important pathological basis for the interpretation of arrhythmia and myocardial enzyme abnormalities in patients with SARS.