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目的探讨糖尿病心肌病的病理形态学特点、诊断、鉴别诊断及其发生机制。方法对40例糖尿病及40例非糖尿病尸检心肌进行临床、组织形态学及测微观察。结果 40例糖尿病中36例(90.0%)有微小心肌细胞坏死,37例(92.5%)有微小心肌间纤维瘢痕灶形成;40例非糖尿病仅8例(20.0%)有微小心肌细胞坏死,9例(22.5%)有微小心肌间纤维瘢痕灶形成;二组相比较差异有统计学意义(P<0.01)。糖尿病组心肌间微小血管壁明显增厚[(20.6±4.2)μm],与对照组[(7.2±5.2)μm]比较差异有统计学意义(P<0.01)。糖尿病组心肌病变与非糖尿病组高血压性心肌病变相似。结论糖尿病心肌病的病理诊断应首先排除引起心肌病变的其他疾病,再根据有长期糖尿病病史及前述心肌的病理组织形态学特征进行诊断;糖尿病心肌细胞微小坏死可能和心肌间微小血管壁明显增厚、缺血、缺氧有关。
Objective To investigate the pathomorphological features, diagnosis, differential diagnosis and mechanism of diabetic cardiomyopathy. Methods 40 cases of diabetes mellitus and 40 cases of non-diabetic autopsy myocardium clinical, histological and microscopic observations. Results Thirty-six cases (90.0%) of 40 cases had micro cardiomyocyte necrosis and 37 (92.5%) had tiny myocardial scar formation. Only 40 cases (20.0%) of non-diabetic patients had micro cardiomyocyte necrosis and 9 There were slight myocardial interstitial fibrosis in 22.5% cases (P <0.01). The difference between the two groups was statistically significant (P <0.01). Compared with the control group [(7.2 ± 5.2) μm], there was significant difference between the diabetic group and the control group [(20.6 ± 4.2) μm] (P <0.01). Cardiomyopathy in diabetic group was similar to hypertensive cardiomyopathy in non-diabetic group. Conclusion The pathological diagnosis of diabetic cardiomyopathy should first exclude other diseases that cause myocardial lesions, and then diagnosed according to the history of chronic diabetes mellitus and the histopathological features of the myocardium. The minimal necrosis of diabetic cardiomyocytes may be significantly increased , Ischemia, hypoxia related.