晚期恶性肿瘤患者阿霉素疗程前后心肌的亚微结构改变

阿霉素(ADR)可致卉叶量依赖性心肌病,故临床化疗往往受到限制。为了解其对心肌的毒性作用,我们对5例晚期恶性肿瘤患者(骨肉瘤2例;纤维肉瘤、肝癌、恶性淋巴瘤各1例),分别在阿霉素化疗前后,各取心内膜心肌活检进行电镜观察,并对比其亚细胞结构之改变。结果发现:化疗前少数细胞质膜局部缺损,肌质网、横管呈囊泡状扩张,闰盘间隙扩大;线粒体增生,部分肿胀退变,心肌原纤维局灶性溶解脱失。胞质内脂褐素颗粒增多。化疗后以上病变继续存在且加重,并见部分线粒体内外膜溶解消失,仅呈嵴群堆集残留者。胞质内出现小脂滴,脂褐素颗粒更为增多。

ULTRASTRUCTURAL CHANGES OF MYOCARDIAL CELLS IN PATIENTS WITH ADVANCED MALIGNAT TUMORS BEFORE AND AFTER ADMINISTRATION OF ADRIAMYCIN

In order to investigate the myocardial changes in patients with malignant tumors in the late stage before and after adriamycin(ADR)administration, the electron microscopic observation and comparison of 5 cases (osteosarcoma 2, fibrosarcoma 1, liver carcinoma 1, malignant lymphoma 1) were conduced. The changes of myocardial cells before ADR administration are: (1) distension of sarcoplasmic reticulum and some T-tubules: vacuolar dilatation of some intercalated discs; the local area of the sarcolemma defects, (2) hyperplastic mitochondria witn swelling, (3) focal myofibrillar loss and numerous lipofuscin granules in the cytoplasm. The changes after ADR administration were the same as those before administration, but more prominent. In addition, some mitochondria botn of their external and internal membranes were all lysed and disappeared. Only a group of cristae were remained. According to our observation, the myocardial cells before ADR administration have some submicroscopic changes. These changes may be produced by some toxic metabolites in the patients. Our sstudies suggest that the cnanges are a latent crisis for the patient, although they are only a ubclinical phenomenon.