Morfološki i patohistološki nalaz na srcu obdukovanih korisnika heroina
Sažetak
Uvod/Cilj. Heroin je polusintetska droga iz grupe opioida, koja može izazvati morfološke i patohistološke promene na srcu: hipertrofiju komora, fibrozu miokarda, hipertrofiju kardiomiocita, izvijuganost miofibrila, gubitak jedara i poprečne ispruganosti miocita, perivaskularna krvarenja i zapaljenski infiltrat. Cilj rada bio je da se prikažu morfološke i patohistološke promene kod obdukovanih osoba sa pozitivnim toksikološkim nalazom metabolita heroina: 6-monoacetilmorfina (6-MAM) i morfina. Metode. Retrospektivna studija je rađena u Institutu za patologiju i sudsku medicinu Vojnomedicinske akademije u Beogradu na 27 osoba starosti od 18 do 60 godina obdukovanih u periodu od 2010. do 2014. godine. Analizirani su debljina zida komora i patohistološki nalaz isečaka miokarda, obrađenih standardnom procedurom i obojenih hematoksilin-eozin (H&E) i trihromnim bojenjem (Masson). U uzorcima krvi i urina analizirane su koncentracije 6-MAM-a i morfina primenom tečne hromatografije sa detektorom visokih performansi sa fotodiodom (HPLC-PDA) ultravioletnim (UV) detektorom. Rezultati. Debljina zidova komora srca bila je kod 27/27 (100%) obdukovanih veća od normalne i to leva 1,74 ± 0,17 cm, a desna 0,6 ± 0,09 cm; fibroza miokarda kod 27/27 (100%) i to perivaskularna kod 24/27 (88,89%), a fokalna intersticijalna kod 3/27 (11,11%) obdukovanih; hipertrofija kardiomiocita kod 22/27 (81,48%); izvijuganost miofibrila kod 22/27 (81,48%); gubitak jedara i poprečne ispruganosti miocita kod 10/27 (37,04%); sveže perivaskularno krvarenje kod 23/27 (85,19%); fokalni zapaljenski infiltrat kod 14/27 (51,85%). Toksikološkom analizom kod 27/27 (100%) obdukovanih su nađeni 6-MAM i morfin u urinu. Zajedno u krvi nađeni su 6-MAM i morfin kod 3/27 (11,11%), a samo morfin kod 16/27 (59,26%) obdukovanih. Zaključak. Našim istraživanjem utvrđene su morfološke (hipertrofija leve i desne komore srca) i patohistološke promene (fibroza miokarda, hipertrofija kardiomiocita, izvijuganost miofibrila, gubitak jedara i poprečne ispruganosti miocita, sveže perivaskularno krvarenje, fokalni inflamatorni infiltrat) kod obdukovanih heroinomana. Te promene su nespecifične i mogu biti uslovljene dugotrajnom upotrebom heroina, ali i nizom drugih faktora. Zbog nedostatka medicinske dokumentcije ispitanika ne možemo isključiti mogućnost da ostali faktori, pored dugotrajne upotrebe heroina, mogu biti uzrok opisanih promena na srcu.
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