早期心肌缺血所致猝死心肌NF-κB以及Ⅰ型胶原蛋白的表达研究

发布时间：2018-03-16 21:56

本文选题：法医病理学　切入点：心脏性猝死　出处：《四川大学》2007年硕士论文　论文类型：学位论文

【摘要】： 研究背景：心脏性猝死多数由急性心肌缺血引起，而急性心肌缺血多发生于冠心病心肌梗死和原因不明的心脏性猝死(如青壮年猝死综合征、心脏抑制性猝死)，晚期或者陈旧性心肌梗死通过心肌梗死灶可以判断其死因，而早期心肌缺血的诊断目前主要依靠常规HE染色观察心肌形态学的改变来诊断。因而法医病理的死因鉴定中，早期心肌缺血的诊断具有重要的实践意义，同时早期急性心肌缺血病理诊断也一直法医病理学实践中亟待解决的难题。故寻找更多的、敏感的早期心肌缺血诊断指标是法医学研究的重点内容。核因子NF-κB广泛存在于真核生物体内，是信号传导途径中的枢纽，也存在于血管内皮细胞、血管平滑肌细胞以及心肌细胞中，并且参与急性心肌缺血病理学改变。心肌Ⅰ型胶原蛋白是心肌间质的重要组成成分之一，，具有很强的抗张能力，不仅对心肌细胞起支持作用、保护、润滑、制约作用，同时也有绝缘性能，是一个处于动态合成、降解的系统。Ⅰ型胶原是心脏含量最多的胶原，并且参与早期心肌缺血、心肌梗死。本研究通过对心脏性猝死案例中人心肌中核因子NF-κB和Ⅰ型胶原蛋白的免疫组织化学检测，原位观察缺血心肌中两个因子的免疫组织化学变化，为早期心肌缺血所致猝死的诊断寻找更为可靠的依据。研究目的：研究心脏性猝死时核因子NF-κB和Ⅰ型胶原蛋白的改变，寻找早期心肌缺血的诊断指标。研究方法：所有的案例来源于四川大学华西基础医学与法医学院法医病理学教研室，将所有符合纳入标准的尸体解剖案例的存档蜡块根据HE染色后光镜下形态学的观察结果，分为3组，即对照组、早期心肌缺血组、心肌梗死组。将这三组分别做特殊染色，免疫组织化学方法染色，并用Axiotis标准比较各组心肌内的I型胶原蛋白和核因子NF-κB免疫反应阳性产物，并用SPSS12.0软件进行统计学分析。研究结果：苏木素-碱性复红-苦味酸-丙酮染色法(HBFP)：缺血心肌呈鲜红色，正常心肌为黄色。核因子NF-κB免疫组织化学染色：对照组心肌细胞染色后，细胞核以及细胞浆未见着色。心肌梗死组心肌细胞浆棕黄色，局部有棕黄色颗粒沉着，并且心肌核有棕黄色物质沉着。早期心肌缺血组缺血心肌细胞浆呈棕黄色，局部有棕褐色颗粒沉着。 Ⅰ型胶原蛋白免疫组织化学染色：对照组心肌纵切面、心肌横切面上，胶原呈网状结构分布。心肌梗死组心肌细胞周围胶原仅有少量存在或者全部消失，早期心肌缺血组可见心肌周围胶原网状结构破坏、不连贯，胶原网变细消失，心肌细胞间隙增大。研究结论：核因子NF-κB和Ⅰ型胶原蛋白对早期心肌缺血猝死有一定诊断意义，可以用做早期心肌缺血的诊断指标。
[Abstract]:Background: sudden cardiac death is mostly caused by acute myocardial ischemia, and acute myocardial ischemia mostly occurs in myocardial infarction of coronary heart disease and unexplained sudden cardiac death (such as sudden death syndrome in young adults). Sudden cardiac death, late or old myocardial infarction can be used to determine the cause of death through myocardial infarction. At present, the diagnosis of early myocardial ischemia mainly depends on routine HE staining to observe the changes of myocardial morphology. Therefore, the diagnosis of early myocardial ischemia is of great practical significance in forensic pathology. At the same time, the diagnosis of early acute myocardial ischemia has always been a difficult problem to be solved in the practice of forensic pathology. Sensitive early diagnosis of myocardial ischemia is the focus of forensic research. Nuclear factor NF- 魏 B exists widely in eukaryotes, is the hub of signal transduction pathway, and also exists in vascular endothelial cells. Vascular smooth muscle cells and cardiomyocytes are involved in the pathological changes of acute myocardial ischemia. Myocardial type I collagen is one of the important components of myocardial interstitial. Protective, lubricating, restrictive, but also insulating, is a dynamic synthetic, degradable system. Type I collagen is the most abundant collagen in the heart and is involved in early myocardial ischemia. Myocardial infarction. In this study, the immunohistochemical changes of NF-魏 B and collagen I in human myocardium were observed in situ by means of immunohistochemical detection of the two factors in the myocardium of patients with sudden cardiac death. To find a more reliable basis for the diagnosis of sudden death caused by early myocardial ischemia. Objective: to study the changes of NF-魏 B and type I collagen during sudden cardiac death and to find out the diagnostic index of early myocardial ischemia. Methods: all the cases came from the Forensic Pathology Department of the West China College of basic Medicine and Forensic Medicine, Sichuan University. The archived wax pieces of all the cadaveric cases that met the inclusion criteria were observed under light microscope according to the results of HE staining. They were divided into three groups: control group, early myocardial ischemia group and myocardial infarction group. Type I collagen and NF-魏 B immunoreactive products were compared with Axiotis standard and analyzed statistically by SPSS12.0 software. Results of the study:. Hematoxylin-basic polyred-picric acid-acetone staining: ischemic myocardium was bright red and normal myocardium was yellow. Nuclear factor NF- 魏 B immunohistochemical staining: after myocardial cell staining in control group, the nucleus and cytoplasm were not stained. In myocardial infarction group, the cytoplasm of myocardial cells was brownish yellow, and there were brown granules in the myocardium. In early myocardial ischemia group, the cytoplasm of myocardial cells was brown and brown granules were present. Type I collagen immunohistochemical staining: in the control group, collagen was distributed in the longitudinal section and on the transverse section of myocardium. In myocardial infarction group, there was only a small amount of collagen around the myocardial cells or all the collagen disappeared. In the early myocardial ischemia group, the collagen reticular structure was destroyed, the collagen reticulum disappeared, and the gap between myocardial cells increased. Conclusion: the nuclear factor NF- 魏 B and collagen I have certain diagnostic significance for early myocardial ischemia sudden death, and can be used as diagnostic index of early myocardial ischemia.
【学位授予单位】：四川大学
【学位级别】：硕士
【学位授予年份】：2007
【分类号】：D919

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