大鼠实验性脑梗死早期CT值及GFAP表达的动态研究
发布时间：2019-07-01 17:31
【摘要】： 【研究背景】脑梗死病例在法医学活体鉴定和临床神经科中并不少见,患者往往遗留较严重的后遗症状。因其发病原因既可以是病理性的也可以由外伤所致,所以鉴别脑梗死发病过程中伤与病的关系是正确评价外伤后脑梗死患者损伤程度的前提。同时,如何科学认定也是法医学工作者的重要任务。在多个鉴别因素中,我们认为脑梗死的发生时间是鉴别伤与病的关键因素之一。因梗死后脑组织发生水肿,在CT上可表现出脑梗死区域的低密度灶。因此,目前CT在临床上已经成为脑梗死首选的检查手段,也成为临床法医鉴定中诊断脑梗死的重要依据;另外,胶质纤维酸性蛋白(glial fibrillouy acidic protein, GFAP)是星形胶质细胞的标志,也是研究脑损伤病理形态变化和推断损伤时间的标志分子之一。但是目前对于脑梗死后CT值及GFAP表达变化的动态研究还很少,所以,探讨上述两项指标在脑梗死后的变化规律就成为本研究的核心内容。 【目的】从影像学、病理形态学及分子水平探讨脑梗死的变化规律,以间接推测脑梗死发生的时间。为临床法医检案中正确的判断脑梗死与外伤的关系提供有力的依据。 【材料与方法】Wistar成年大鼠55只,雌雄不拘。分为11组,每组5只,分别为对照组、假手术组和实验组。其中对照组1组,假手术组按处死时间分为3h、6h和12h三组,实验组按伤后分别饲养存活2h、3h、4h、6h、8h、12h、24h分为七组,复制成永久性大脑中动脉梗死动物模型。同期行大鼠大脑冠状CT扫描,记录CT值,并请有经验的放射科医生盲法阅片。CT扫描后灌流固定,脑组织取材切片,HE染色观察形态学的改变,免疫组化方法检测GFAP的表达水平。对梗死后脑组织CT值及GFAP表达变化与损伤时间的关系进行分析,并与伤后不同时相的病理变化进行对比。 【结果】实验组大鼠脑梗死后2h,全部动物CT扫描均未发现明确的梗死灶,3h组有2只动物发现梗死灶,界限不清。至6h全部动物均出现明确梗死灶。且自3h后大脑中动脉供血区脑组织出现不同程度的低密度,随着时间的推移,密度逐渐降低。脑梗死两侧CT值的差值逐渐增大。且其差值与梗死时间呈显著直线正相关(相关系数r=0.967,P0.05,回归方程:Y=0.158+0.58X)。即梗死时间每增加1h,健、患两侧CT值的差值平均增加0.738HU。脑梗死后24h内,脑组织经历缺血、变性、坏死伴脑水肿,神经元及神经纤维破裂,细胞核固缩、溶解等一系列改变。梗死后3h脑白质已出现水肿及核固缩表现,但程度较轻,呈灶状;梗死后6h,脑白质水肿及核固缩程度加重;梗死后12h,细胞核固缩、核溶解、组织疏松校明显;到梗死后24h,核固缩、核溶解十分明显,组织疏松十分明显。同时,GFAP的表达随脑梗死的时间延长也发生规律性的变化。正常脑组织中,GFAP阳性反应较低,细胞体积较小,突起纤细。脑梗死后6h,星形胶质细胞主要局限于梗死区周围,GFAP阳性反应增加,染色加深,突起增多。梗死后12h,星形胶质细胞胞体肥大,GFAP阳性细胞面积百分比明显增加。梗死后24h,星形胶质细胞波及全脑,GFAP阳性细胞面积百分比持续增大。 【结论】脑梗死后脑组织水肿是导致CT值较健侧降低的主要病理基础,随梗死时间的延长,梗死区域脑组织水肿程度逐渐加重是导致CT值进行性下降的重要原因。GFAP是研究脑损伤病理形态变化和推断损伤时间的标志分子之一。健、患侧CT值的差值及GFAP的表达均显示出显著的时间相关性。脑梗死后至少6小时才可以从所有动物CT图像上观察到明确的梗死灶,且随梗死时间的延长,梗死灶的密度逐渐降低,面积逐渐增大。这些对于法医学上正确运用CT图像初步估计脑梗死的发生时间及掌握鉴定时机有明确的指导性,也为脑梗死的进一步影像学研究提供了依据。同时,脑梗死后形态学的变化及GFAP的表达也与梗死时间有相关性,这些不仅为正确理解脑梗死病理基础和进一步的病理学研究提供了重要的依据,也从分子水平为法医学鉴定中梗死时间推断、鉴定时机的掌握等提供了依据。
[Abstract]:[Study Background] The case of cerebral infarction is not uncommon in the in-vivo identification and clinical neurology of forensic medicine. The patient is often left with a more serious sequela. Because the cause of the disease is both pathological and traumatic, it is an important task to evaluate the degree of injury of the patients with cerebral infarction after trauma. At the same time, how to determine the time of the cerebral infarction is one of the key factors in the identification of the injury and the disease. In the multiple identification factors, we think that the time of the cerebral infarction is one of the key factors for the differential injury and the disease. In the multiple identification factors, we think that the time of the cerebral infarction is one of the key factors for the differential injury and the disease. In addition, the present CT has become the first choice for the diagnosis of cerebral infarction, and it is one of the markers for the diagnosis of cerebral infarction in the clinical forensic appraisal. In addition, the glial fibrillary acidic protein (GFAP) is the marker of the astrocyte, and it is also a marker of the change of the pathological form and the time of the inferring the injury time of the brain injury. But the CT value and the GFAP after cerebral infarction are currently the important task in the study of the post-cerebral infarction. [Objective] To study the change of cerebral infarction from imaging, pathomorphology and molecular level, to indirectly estimate the time of cerebral infarction. The experimental group was divided into 11 groups,5 rats in each group, control group, sham operation group and experimental group. The experimental group was divided into three groups: the control group, the sham operation group and the experimental group. The experimental group was divided into seven groups according to the sacrifice time. The experimental group was divided into seven groups according to the sacrifice time. The experimental group was divided into seven groups. The experimental group was divided into seven groups according to the death time. The experimental group was divided into seven groups. The experimental group was divided into seven groups. The experimental group was divided into seven groups. The experimental group was divided into seven groups. The experimental group was divided into seven groups. The experimental group was divided into seven groups. The experimental group was divided into seven groups, and then it was copied into the permanent cerebral artery infarction animal model. In the same time, the brain of the rat brain was scanned, the CT value was recorded, and the change of morphology was observed by HE staining. The expression level of GFAP was detected by immunohistochemistry. The relationship between the CT value of the brain tissue and the expression of GFAP and the time of injury in the post-infarction brain tissue was analyzed and compared with the injury time. The results were compared with the pathological changes of the non-simultaneous phase.[Results] In the experimental group, no definite infarction range was found in all the animals after the cerebral infarction in the experimental group,2 animals in the 3 h group were found to have the infarction range, and the margin was not clear. All the animals in the brain after 3 h had a low density, and the density gradually decreased with the lapse of time. The difference between the CT values at the two sides of the cerebral infarction was gradually increased, and the difference was positively correlated with the time of the infarction (the correlation coefficient r = 0.967, P0.05). The regression equation: Y = 0.158 + 0.58X), that is, the difference between the CT values of the two sides increased by 0.738 HU for every 1 h after the infarction. In 24 hours after the cerebral infarction, the brain tissue experienced ischemia, degeneration, necrosis and brain edema, rupture of the neurons and nerve fibers, the core of the cells, and the dissolution of the brain. After the infarction, the white matter of the brain had appeared edema and the core-fixation, but the degree of the cerebral white matter edema and the degree of core fixation increased. At the same time, the expression of GFAP increased with the time of the cerebral infarction. At the same time, the expression of GFAP increased with the time of the cerebral infarction. In the normal brain tissue, the GFAP positive reaction was low, the volume of the cells was small, and the protrusion was fine. At the same time, the expression of GFAP was mainly limited to the area around the infarction area, the positive reaction of GFAP was increased, the staining was deepened, and the protrusion The area percentage of the whole brain and GFAP positive cells continued to increase.[Conclusion] The edema of brain tissue after cerebral infarction is the main pathological basis of the decrease of CT value, and the gradual increase of the degree of edema in the brain tissue of the infarction area is an important cause of the progressive decrease of CT value. The GFAP is one of the marker molecules in the study of the pathological changes of the brain injury and the time of the deduction of the injury time. The difference between the CT value of the affected side and the expression of the GFAP show a significant time correlation. The difference between the CT value of the affected side and the expression of the GFAP show a significant time correlation. The difference between the CT value of the affected side and the expression of the GFAP show a significant time correlation. The time of the onset of the cerebral infarction and the expression of the GFAP in the case of cerebral infarction have a clear guidance, and it also provides the basis for further imaging study of the cerebral infarction.
【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
本文编号：2508671
[Abstract]:[Study Background] The case of cerebral infarction is not uncommon in the in-vivo identification and clinical neurology of forensic medicine. The patient is often left with a more serious sequela. Because the cause of the disease is both pathological and traumatic, it is an important task to evaluate the degree of injury of the patients with cerebral infarction after trauma. At the same time, how to determine the time of the cerebral infarction is one of the key factors in the identification of the injury and the disease. In the multiple identification factors, we think that the time of the cerebral infarction is one of the key factors for the differential injury and the disease. In the multiple identification factors, we think that the time of the cerebral infarction is one of the key factors for the differential injury and the disease. In addition, the present CT has become the first choice for the diagnosis of cerebral infarction, and it is one of the markers for the diagnosis of cerebral infarction in the clinical forensic appraisal. In addition, the glial fibrillary acidic protein (GFAP) is the marker of the astrocyte, and it is also a marker of the change of the pathological form and the time of the inferring the injury time of the brain injury. But the CT value and the GFAP after cerebral infarction are currently the important task in the study of the post-cerebral infarction. [Objective] To study the change of cerebral infarction from imaging, pathomorphology and molecular level, to indirectly estimate the time of cerebral infarction. The experimental group was divided into 11 groups,5 rats in each group, control group, sham operation group and experimental group. The experimental group was divided into three groups: the control group, the sham operation group and the experimental group. The experimental group was divided into seven groups according to the sacrifice time. The experimental group was divided into seven groups according to the sacrifice time. The experimental group was divided into seven groups. The experimental group was divided into seven groups according to the death time. The experimental group was divided into seven groups. The experimental group was divided into seven groups. The experimental group was divided into seven groups. The experimental group was divided into seven groups. The experimental group was divided into seven groups. The experimental group was divided into seven groups. The experimental group was divided into seven groups, and then it was copied into the permanent cerebral artery infarction animal model. In the same time, the brain of the rat brain was scanned, the CT value was recorded, and the change of morphology was observed by HE staining. The expression level of GFAP was detected by immunohistochemistry. The relationship between the CT value of the brain tissue and the expression of GFAP and the time of injury in the post-infarction brain tissue was analyzed and compared with the injury time. The results were compared with the pathological changes of the non-simultaneous phase.[Results] In the experimental group, no definite infarction range was found in all the animals after the cerebral infarction in the experimental group,2 animals in the 3 h group were found to have the infarction range, and the margin was not clear. All the animals in the brain after 3 h had a low density, and the density gradually decreased with the lapse of time. The difference between the CT values at the two sides of the cerebral infarction was gradually increased, and the difference was positively correlated with the time of the infarction (the correlation coefficient r = 0.967, P0.05). The regression equation: Y = 0.158 + 0.58X), that is, the difference between the CT values of the two sides increased by 0.738 HU for every 1 h after the infarction. In 24 hours after the cerebral infarction, the brain tissue experienced ischemia, degeneration, necrosis and brain edema, rupture of the neurons and nerve fibers, the core of the cells, and the dissolution of the brain. After the infarction, the white matter of the brain had appeared edema and the core-fixation, but the degree of the cerebral white matter edema and the degree of core fixation increased. At the same time, the expression of GFAP increased with the time of the cerebral infarction. At the same time, the expression of GFAP increased with the time of the cerebral infarction. In the normal brain tissue, the GFAP positive reaction was low, the volume of the cells was small, and the protrusion was fine. At the same time, the expression of GFAP was mainly limited to the area around the infarction area, the positive reaction of GFAP was increased, the staining was deepened, and the protrusion The area percentage of the whole brain and GFAP positive cells continued to increase.[Conclusion] The edema of brain tissue after cerebral infarction is the main pathological basis of the decrease of CT value, and the gradual increase of the degree of edema in the brain tissue of the infarction area is an important cause of the progressive decrease of CT value. The GFAP is one of the marker molecules in the study of the pathological changes of the brain injury and the time of the deduction of the injury time. The difference between the CT value of the affected side and the expression of the GFAP show a significant time correlation. The difference between the CT value of the affected side and the expression of the GFAP show a significant time correlation. The difference between the CT value of the affected side and the expression of the GFAP show a significant time correlation. The time of the onset of the cerebral infarction and the expression of the GFAP in the case of cerebral infarction have a clear guidance, and it also provides the basis for further imaging study of the cerebral infarction.
【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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