日本医科大学雑誌
Online ISSN : 1884-0108
Print ISSN : 0048-0444
ISSN-L : 0048-0444
刺激伝導系の加齢的変化に関する病理組織学的研究
田近 豊一郎
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1982 年 49 巻 4 号 p. 494-509

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Histopathological changes of the conduction system of the heart were studied with special reference to the aging process in 31 autopsy cases, which were not accompanied by circulatory diseases. Particular attention was paid to the correlation between the histopathology of the sinus node, atrioventricular node, His bundle and both bundle branches, and designated perfusing arteries and their branches.
A significant correlation was demonstrated between age and the sclerotic changes of the sinus node artery. Similar significant correlations were also observed between age and the sclerotic changes of the arteries and their branches which perfuse AV node and more distal portions, indicating that sclerotic changes became more marked as aging progressed. As these findings, however, were not so striking, the changes were not identifiable as indisputable “arteriosclerosis”.
Accordingly, certain factors must be considered to contribute to the development of arteriosclerosis in addition to aging. It was noted that the arteriosclerosis was observed even in newborn infants having marked abnormalities in the circulatory system, such as congenital cardiac malformations, indicating that the circulatory derangement might beone of its causes.
There were positive correlations between age and the histopathological changes of SA and AV nodes, His bundle and both branches. However, the decrease of the number of the conduction cells to less than 50%, which is regarded as the significant pathological change, was not confirmed in the cases studied.
Positive correlation was also confirmed between the extent of the histological injury of SA and AV nodes and the changes of their perfusing arteries. The histological changes of the His bundle were similarly correlated with the changes of the ramus septi fibrosi and ramus septi ventriculorum superior, which perfuse this portion, but the correlation with the right coronary artery was not significant.
There were two types of histological changes associated with the decrease of conduction cells: one is the replacement by the adiposal tissue and the other by the increase of collagenous fibers. Both types of changes increased with age in SA node, while the His bundle and AV node showed the aging preponderance of the fibro-collagenous type.
In conclusion, the histological changes of the conduction system and sclerotic changes of perfusing arteries were observed to progress with age, but the degree of changes was rather minimal or slight. It is suggested that additional factors, such ascirculatory derangement, should be considered to contribute to the development of indisputable arteriosclerosis.

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