冠心病猝死者冠状动脉粥样硬化斑块C-反应蛋白表达的研究
本文选题:C-反应蛋白(CRP) + 冠心病猝死 ; 参考:《华中科技大学》2006年硕士论文
【摘要】: [目的]冠心病猝死(sudden coronary death, SCD)的病理诊断一直是法医病理学的重要研究课题之一,多年来,国内外研究人员对此进行了大量探讨。SCD发生的病理基础是冠状动脉(以下简称冠脉)粥样硬化,但是由于SCD发生迅速、多发生在院外,且肉眼观察和常规组织学切片H.E.染色镜检很难发现明显的病理形态学改变,所以一直到现在,法医学检案仍然延续常规的排他性诊断,而未找到SCD诊断的“金标准”。传统研究的注意力多集中在早期心肌缺血和心肌缺血再灌注损伤等方面。上世纪70年代研究者发现了血清炎症反应标志物C-反应蛋白(C-reactive protein, CRP)、白介素(interleukin, IL)、肿瘤坏死因子(tumor necrosis factor, TNF)等一批炎症相关因子后,一些学者对于冠心病(coronary heart disease, CHD)发生的传统定义——脂质沉积过程才有所置疑。1999年Ross第一次明确提出“动脉粥样硬化是一种炎性疾病”的假说,认为动脉粥样硬化(atherosclerosis, AS)不仅仅是脂质沉积过程,而是由炎症贯穿了AS发生发展的全过程。之后大量研究围绕炎症与AS的关系展开,有学者研究发现CRP水平的升高和急性冠脉综合征的发生密切相关。但SCD者冠脉粥样硬化斑块内的CRP表达情况尚未见报道。为此,我们应用免疫组化和图像分析技术来定性和半定量检测CRP在SCD者冠脉粥样硬化斑块内表达的变化,以探讨其作为死后SCD诊断指标的意义。 [方法]从本教研室2001~2004年法医病理学尸检档案中挑选从死亡时间至尸检时间在48小时以内的案例共68例,并搜集其原始档案资料及其心脏标本、蜡块和H.E.切片。分为A组(SCD组,实验组)、B组(CHD非心脏性疾病死亡组,对照组Ⅰ)和C组(无明显冠脉粥样硬化组,对照组Ⅱ)三组。选择病例的标准是:三组均排除细菌感染、病毒感染、急慢性炎症、肿瘤及免疫性疾病。A组和B组每例冠脉的左前降支(left anterior descending, LAD)和右主支(right main, RM)内膜AS斑块病变达3级或3级以上,而不考虑另外两个分支左主干(left main, LM)和左旋支(left circumflex, LC)有无病变及其等级;C组冠脉四个分支均无明显粥样硬化病变或仅有1级的轻度病变。A组排除暴力死及其它疾病所致的死亡,明确诊断为SCD,其猝死时间按WHO标准,从症状发作到死亡时间在24小时内;B组、C组的死亡原因是暴力死或非心脏性疾病(如脑出血、中毒、机械性窒息、机械性损伤等)所致。运用免疫组化染色技术SABC法和图像分析技术,对三组冠脉粥样硬化斑块内CRP表达情况进行定性、半定量检测和统计学分析。 [结果] A组27例,其中,男20例,女7例;年龄30~74岁,平均50.30岁;从死亡到尸检时间为48h以内;冠脉粥样硬化斑块病变4级22例,3级5例;心重220g~510g,平均388.22g。B组21例,其中,男18例,女3例;年龄35~81岁,平均52.19岁;冠脉粥样硬化斑块病变4级8例,3级13例;心重220g~495g,平均379.29g;死因为外伤性脑出血8例,中毒4例,机械性窒息1例,机械性损伤1例,病理性脑出血3例,主动脉夹层破裂1例,脑水肿、脑疝形成1例,肺脂肪栓塞1例,脑梗死1例。C组20例,其中,男12例,女8例,年龄17~42岁,平均28.70岁;心重210g~350g,平均293.50g,冠脉内膜未见增厚者2例,轻度增厚1级者18例;死因为脑外伤5例,中毒4例,电击1例,机械性损伤3例,机械性窒息1例,肺脂肪栓塞1例,肺羊水栓塞4例,癫痫发作1例。免疫组织化学染色:A组27例中,21例强阳性表达,6例出现较强阳性表达; B组21例中,3例较弱阳性表达,11例出现微弱阳性表达,7例未见阳性表达;C组冠脉内膜及轻度增厚处未见CRP阳性反应。经图像分析检测并进行统计分析结果表明,SCD组与对照组Ⅰ冠脉粥样硬化斑块中CRP表达的OD值和R值的差异有显著性意义(P 0.01),与对照组Ⅱ相比,其冠脉粥样硬化斑块中CRP表达的OD值和R值的差异也有显著性意义(P 0.01);而两对照组间冠脉粥样硬化斑块中CRP表达的差异无显著性意义。 [结论] SCD组冠脉粥样硬化斑块中CRP表达呈阳性,其表达的OD值和R值与两个对照组相比的差异有显著性意义;认为这种差异可能与SCD的发生有一定的关系;其冠脉粥样硬化斑块中CRP的表达情况,可作为SCD者死后法医病理学诊断的一个有用指标。
[Abstract]:[Objective] the pathological diagnosis of sudden coronary death (SCD) is one of the most important research topics in forensic pathology. For many years, researchers at home and abroad have carried out a great deal of research on the pathological basis of the occurrence of.SCD, which is the coronary atherosclerosis (hereinafter referred to as coronary) atherosclerosis, but because of the rapid occurrence of SCD, many of them occur outside the hospital. It is difficult to find obvious pathological changes of Pathomorphology by the naked eye observation and the routine histological section H.E. staining microscopy, so the forensic case still continues to continue the routine exclusive diagnosis, but does not find the "gold standard" for the SCD diagnosis. The attention of the traditional study is mainly focused on the early myocardial ischemia and myocardial ischemia reperfusion injury and so on. In the 70s, researchers found the C- reactive protein (C-reactive protein, CRP), interleukin (IL), and tumor necrosis factor (tumor necrosis factor, TNF) and other inflammatory factors, and some scholars had a traditional definition of lipid peroxidation (coronary heart). The process of deposition was doubted that Ross was the first hypothesis that "atherosclerosis is an inflammatory disease" for the first time in.1999, that atherosclerosis (atherosclerosis, AS) is not only a process of lipid deposition, but that inflammation runs through the whole process of the development of AS. A lot of research has been conducted around the relationship between inflammation and AS. The study found that the elevation of CRP level is closely related to the occurrence of acute coronary syndrome. But the expression of CRP in the atherosclerotic plaque of SCD has not yet been reported. Therefore, we use immunohistochemical and image analysis techniques to determine the changes in the expression of CRP in the atherosclerotic atherosclerotic plaque of SCD. The significance of the SCD diagnostic index after death.
[Methods] 68 cases were selected from the 2001~2004 year forensic pathology autopsy records of the Department of education and research in 48 hours from the death time to the autopsy. The original files and their heart specimens, wax blocks and H.E. sections were collected and divided into group A (group SCD, experimental group), group B (CHD non heart disease death group, control group I) and group C (Wu Ming) The coronary atherosclerotic group, the control group II) three groups. The standard of the selected cases was that the three groups all excluded bacterial infection, virus infection, acute and chronic inflammation, the.A group of left anterior descending (LAD) and the right main branch (right main, RM) endometrium of each case of the tumor and immune disease group and the right main branch (right main, RM) endometrium in the group of B and the right main artery (right main, RM) were more than grade 3 or more than grade 3. Two other branches of the left trunk (left main, LM) and left lateral (left circumflex, LC) had no lesions and their grades. The four branches of the C group had no obvious atheromatous lesions or only 1 mild lesions of.A excluded the death of violent death and other diseases. The definite diagnosis was SCD, and the time of sudden death was from the WHO standard, from the symptoms to the symptoms. The death time was 24 hours, and the cause of death in group B and group C was caused by violent death or non heart disease (such as cerebral hemorrhage, poisoning, mechanical asphyxia, mechanical injury, etc.). The CRP expression in the atherosclerotic plaque of coronary artery was qualitatively, semi quantitative and statistically analyzed by immunohistochemical staining technique SABC method and image analysis technique. Analysis.
[results] there were 27 cases in group A, of which 20 were male and 7 women, 30~74 years old and 50.30 years old. The time of death to autopsy was less than 48h; 22 cases of atherosclerotic plaque lesion of coronary artery, 3 grade 5 cases, cardiac weight 220g to 510g, 21 cases in 388.22g.B group, among them, 18, 3, age 35~81 years, atherosclerotic plaque lesions of coronary atherosclerotic plaque In 13 cases, the heart weight was 220g to 495G, with an average of 379.29g, 8 cases of traumatic cerebral hemorrhage, 4 cases of poisoning, 1 cases of mechanical asphyxia, 1 cases of mechanical injury, 3 cases of pathological cerebral hemorrhage, 1 cases of aortic dissection rupture, cerebral edema, 1 cases of cerebral hernia formation, 1 cases of pulmonary fat embolism, 1 cases of cerebral infarction, 1 cases of.C, and average age 17~42 years old. Heart weight 210g to 350g, average 293.50g, no thickening of the intima of coronary artery in 2 cases, mild thickening of 18 cases, 5 cases of brain trauma, 4 cases of poisoning, 1 cases of electrical shock, 3 cases of mechanical injury, 1 cases of mechanical asphyxia, 1 cases of pulmonary fat embolism, 4 cases of pulmonary amniotic fluid embolism, 1 cases of epilepsy, 18 cases of A group, 21 cases strongly positive expression, 6 out of 21 cases of group A, 21 cases, 6 cases out of 21 cases 21 among 6 out of 21 cases in A group 27 cases Of the 21 cases in group B, 3 were weakly positive, 11 had weak positive expression and 7 had no positive expression, and no CRP positive reaction was found in the coronary intima and mild thickening of group C. The results of image analysis and analysis showed that the CRP expression and R value of CRP in the coronary atherosclerotic plaque of the SCD group and the control group I were in the control group. The difference was significant (P 0.01). Compared with the control group II, the difference of CRP expression and R value in the atherosclerotic plaque was also significant (P 0.01), but there was no significant difference in the expression of CRP in the atherosclerotic plaque between the two controls.
[Conclusion] the expression of CRP in coronary atherosclerotic plaques in SCD group was positive, and the expression of OD and R were significantly different from those of the two control groups, and the difference may be related to the occurrence of SCD. The expression of CRP in the atherosclerotic plaque in coronary artery could be used as one of the pathological diagnosis of SCD in the postmortem forensic medicine. Use the index.
【学位授予单位】:华中科技大学
【学位级别】:硕士
【学位授予年份】:2006
【分类号】:D919
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