proBNP、NTproBNP及sST2在冠心病猝死者体内的表达

发布时间：2018-04-08 14:47

  本文选题：法医病理学　切入点：冠心病　出处：《山西医科大学》2017年硕士论文

【摘要】：目的:研究冠心病猝死者心肌中脑利钠肽前体(proBNP)及心血中氨基末端脑利钠肽前体(NTproBNP)和可溶性ST2(sST2)的表达变化,探讨proBNP、NTproBNP、sST2在法医学实践中诊断冠心病猝死及心肌缺血严重程度的应用价值。方法:选取山西医科大学司法鉴定中心2011-2016年尸检案例标本共60例,分为冠心病猝死组、单纯冠脉狭窄组及正常对照组,每组各20例。每个案例取左心室前壁及左心室后壁各一块及右心血样本10ml。运用免疫组织化学染色、Western印迹法检测心肌样本中proBNP的表达;采用RT-qPCR技术检测心肌中BNPmRNA的表达;采用ELISA法检测血浆中NTproBNP和sST2的含量。结果:(1)冠心病猝死组、单纯冠脉狭窄组心肌组织中proBNP免疫组化染色均为阳性染色,正常对照组未见明显阳性染色。(2)冠心病猝死组、单纯冠脉狭窄组心肌组织proBNP蛋白相对表达量高于正常对照组,差异具有统计学意义(P0.05)。(3)冠心病猝死组、单纯冠脉狭窄组心肌组织内BNPmRNA相对表达量较正常对照组明显升高,差异具有统计学意义(P0.05)。(4)冠心病猝死组、单纯冠脉狭窄组血浆内NTproBNP的含量较正常对照组明显升高;冠心病猝死组、单纯冠脉狭窄组及正常对照组NTproBNP数据两两比较,表达差异均具有统计学意义(P0.05)。(5)冠心病猝死组、单纯冠脉狭窄组血浆内sST2的含量较正常对照组明显升高,冠心病猝死组、单纯冠脉狭窄组及正常对照组sST2数据两两比较,其差异均具有统计学意义(P0.05)。结论:(1)心肌缺血时心肌组织proBNP表达升高,proBNP可作为判断心肌缺血及冠心病猝死辅助指标。(2)测定血浆中NTproBNP和sST2有助于鉴别冠心病的严重程度及是否为冠心病猝死;联合检测proBNP、NTproBNP、sST2对冠心病猝死的诊断更具优势。
[Abstract]:Objective: to study the expression of brain natriuretic peptide precursor proBNPs in myocardium and the expression of N-terminal brain natriuretic peptide precursor NTproBNPand soluble ST2P ST2 in cardiac blood of patients with sudden coronary heart death.To explore the application value of proBNPN NTproBNPsST2 in the diagnosis of sudden death of coronary heart disease and severity of myocardial ischemia in forensic practice.Methods: a total of 60 autopsy specimens were selected from Shanxi Medical University Forensic Identification Center from 2011 to 2016. They were divided into three groups: sudden coronary death group, coronary artery stenosis group and normal control group, with 20 cases in each group.A sample of 10 ml of left ventricular anterior wall and left ventricular posterior wall and 10 ml of right ventricular blood were taken from each case.Immunohistochemical staining was used to detect the expression of proBNP in myocardial samples, RT-qPCR technique was used to detect the expression of BNPmRNA in myocardium, and ELISA was used to detect the contents of NTproBNP and sST2 in plasma.Results proBNP immunohistochemical staining was positive in coronary heart disease sudden death group and simple coronary artery stenosis group, but no obvious positive staining was found in normal control group.The relative expression of proBNP protein in myocardial tissue of coronary artery stenosis group was higher than that of normal control group, and the difference was statistically significant (P 0.05. 01. 3) the relative expression of BNPmRNA in myocardial tissue of coronary artery stenosis group was significantly higher than that of normal control group, and that of coronary artery stenosis group was significantly higher than that of normal control group.The difference was statistically significant (P < 0.05). The plasma NTproBNP level in the coronary artery stenosis group was significantly higher than that in the normal control group, and the NTproBNP data of the coronary artery death group, the simple coronary artery stenosis group and the normal control group were significantly higher than those of the normal control group.The expression of sST2 was significantly higher in patients with coronary artery stenosis than that in control group. The sST2 data of sudden coronary death group, simple coronary artery stenosis group and normal control group were compared with each other.The differences were statistically significant (P 0.05).Conclusion the increased expression of proBNP in myocardial tissue during myocardial ischemia can be used as an auxiliary index to judge myocardial ischemia and sudden death of coronary heart disease. The determination of NTproBNP and sST2 in plasma is helpful to distinguish the severity of coronary heart disease and whether it is sudden death of coronary heart disease.Combined detection of proBNPN NTproBNPs ST2 is more advantageous in the diagnosis of sudden coronary death.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：D919

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