實驗的心筋梗塞の病理組織學的, 組織化學的及び心電圖學的研究 : 第1報冠動脈結紮による心筋の組織化學的變化

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Pathological changes in myocardial infarction usually appear later than the electrocardiographic and quantitative biochemical changes. In order to study this discrepancy, systematic studies of the histochemical changes are carried out in experimental myocardial infarction produced by coronary artery ligation.Method : Twenty-three adult mongrel dogs were used. Myocardial infarction was produced by ligating the anterior descending branch of the left coronary artery between the first and the second left ventricular branch attempting to exclude the accompanying veins and nerves. Animals were killed at the following intervals, 1,1 1/2,2,3,4,10 hours, 1,2,3,4,5,6,7,9,11,16,23,64 and 155 days, and specimens were obtained. As histochemical methods, several enzymes such as succinic dehydrogenase (tetrazolium method), acid and alkaline phosphatase, ATP-ase, lipase, periodic acid Schiff method with and without saliva digestion, metachromasia by toluidine blue, Rinehart's colloidal iron stain, lipid (Sudan black B and Sudan IV), calcium (Kossa and alizarin method) were stained and at the same specimen, Haematoxylin-Eosin, Mallory, Goldner-Masson and elastic fiber stain (Gomori's method) were used.Results : 1. Areas of myocardial degeneration were not evenly distributed, but showed varying degrees of pathological change in a mottled appearance, even in the anterior wall of the left ventricle which showed most remarkable change.2. The earliest histochemical change was a loss of glycogen. After one hour, a marked reduction of glycogen content was noticed without accompanying histological changes. After one day, glycogen of myocardial fibers completely disappeared but at the border of the degenerated or fibrotic area, more than normal amount of glycogen appeared and lasted for several days.3. The neutral fat droplet appeared in myocardial fibers after 3 hours, which were deeply stained with eosin preserving their fine structures. The lipase activity was recognized more distinct in broader area. After 10 hours, fatty degeneration became prominent and 5 to 6 days later, as myocardial fiber became necrotic, neutral fat and lipase activity disappeared. The fatty granular cells, and infiltrated leucocytes showed a distinct activity of lipase. Calcium deposition was seen about the same area and disappeared along with fat droplets.4. The succinic dehydrogenase activity did not decrease within first several hours of infarction and showed a decreased activity after 10 hours. After one day, this activity became completely negative in the same area and after 3 to 4 days, it became completely negative transmurally. The muscle fibers which lost this activity stained deep with eosin uniformly, and showed coagulation necrosis.In the media of arterial wall in the myocardium, faint activity was demonstrated, gradually decreasing with the progress of the myocardial change.5. The activity of ATP-ase and acid phosphatase in myocardial fibers decreased gradually paralleling with succinic dehydrogenase activity. Alkaline phosphatase activity was seen in the capillary walls but muscle fiber showed only a faint activity, so that the influence of circulatory arrest was not evident.6. After 3 to 4 hours, some degenerated muscle contained PAS positive substance and not affected by saliva digestion. This was also metachromasia positive in PH 4.1 of toluidine blue and suggested the presence of acid mucopolysaccharide contained a hyaluronic acid. After 3 to 4 days, newly formed connective tissues showed a remarkable acid mucopolysaccharide reaction contained a sulfate compound, that is metachromasia positive in PH 2.5 of toluidine blue and colloidal iron stain positive. When the connective tissue became older, these reactions were reduced gradually.7. Electrocardiogram was taken directly from the epicardial surface. Just after the ligation, elevation of RS-T segment was seen and the amplitude of R wave decreased gradually showing RS pattern. After one hour the low voltage was observed in 10 of 17 cases, and QS pattern became distinct after 3 to 10 hours. After one day transitory ventricular tachycardia appeared in all. After 3 days RS-T elevation became normal accompanied by a gradual appearance of coronary T wave. After 6 days T wave became positive but QS pattern remained the same after 155 days. It should be noticed that it took about three weeks to repair the histological changes but electrocardiographic changes became stable in 6 days.
社団法人日本循環器学会の論文
1959-01-20

著者

藏本築
東京大學醫學部内科學第三講座:社會福祉法人浴風會

實驗的心筋梗塞の病理組織學的, 組織化學的及び心電圖學的研究 : 第1報冠動脈結紮による心筋の組織化學的變化

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實驗的心筋梗塞の病理組織學的, 組織化學的及び心電圖學的研究 : 第1報 冠動脈結紮による心筋の組織化學的變化

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實驗的心筋梗塞の病理組織學的, 組織化學的及び心電圖學的研究 : 第1報冠動脈結紮による心筋の組織化學的變化