TGF-β异构体在肥厚型心肌病中的表达及意义

发布时间：2018-04-17 00:29

本文选题：心肌病 + 肥厚型　；参考：《青岛大学》2015年硕士论文

【摘要】：【研究背景】心源性猝死指的是,在急性症状发作后1小时内发生的由于心脏疾病原因引起的自然死亡,主要以意识突然丧失为特征。该类猝死一直是法医检案实践中的重要课题之一。对发生SCD者进行尸检发现,大部分案例中能明确观察到心脏相关的器质性病变,如冠状动脉重度狭窄、主动脉夹层破裂、扩张型和肥厚型心肌病等。其中,肥厚型心肌病在我国的发病率约0.2%,是常见遗传性心脏疾病,可发生在各个年龄段,但患者的临床表现异质性极大,存在终生无症状者、快速进展到心力衰竭者或发生心源性猝死为首发症状者。另外,肥厚型心肌病是35岁以下青年人发生SCD的首要原因。目前,对HCM的遗传特性、临床表现、预后评估等都有了较深的研究,但是对HCM的发病机制及原因尚不明确。【目的】本实验旨在研究TGFβ异构体(TGFβ1、TGFβ2、TGFβ3)在肥厚型心肌病患者心肌组织中的表达情况,并与健康对照组进行对比,通过指标的差异性,为法医病理学诊断肥厚型心肌病提供客观指标。【方法】选用56例肥厚型心肌病患者及18例健康对照者的心肌组织,常规HE染色并采用免疫组织化学方法分别检测TGFβ1、TGFβ2、TGFβ3的表达水平,并使用图像分析系统进行结果判断。【结果】1、HE染色结果:肥厚型心肌病组中大部分病理可见局部心肌纤维断裂,心肌肥大,部分患者心肌细胞可见空泡样变及脂褐素沉积,并伴有少量炎细胞浸润及心肌间质水肿、明显纤维化,细胞核呈现多样性,可见畸形核。健康对照组镜下观,心肌纤维排列整齐,横纹清晰,心肌细胞形态正常,胞核大小均匀。2、免疫组织化学染色:TGFβ1、TGFβ2、TGFβ3在肥厚型心肌病患者中表达的平均灰度值分别为120.86±11.73、122.98±9.55、115.21±7.92;TGFβ1、TGFβ2、TGFβ3在健康对照中表达的平均灰度值分别为36.00±5.31、29.84±4.85、29.92±6.80。TGFβ1、TGFβ2、TGFβ3在肥厚型心肌病患者心肌中的表达均高于健康对照组,差异有统计学意义(t=20.18,26.94,28.93,P0.05)。【结论】本研究表明,TGFβ异构体(TGFβ1、2、3)在肥厚型心肌病心肌纤维化的发生发展起重要作用,为法医病理学诊断肥厚型心肌病提供可能的客观指标。
[Abstract]:Background: sudden cardiac death is a sudden loss of consciousness that occurs within an hour after the onset of acute symptoms due to heart disease.This kind of sudden death has always been one of the important subjects in the practice of forensic examination.Autopsy of patients with SCD showed that most of the cases were characterized by cardio-related organic diseases, such as severe stenosis of coronary artery, rupture of aortic dissection, dilated and hypertrophic cardiomyopathy, etc.The incidence of hypertrophic cardiomyopathy in China is about 0.2. It is a common hereditary heart disease. It can occur in all ages, but the clinical manifestations of the patients are very heterogeneous, and there are asymptomatic patients for life.Rapid progression to heart failure or sudden cardiac death is the first symptom.Hypertrophic cardiomyopathy is also the leading cause of SCD in young people under 35 years of age.At present, the genetic characteristics, clinical manifestations and prognosis of HCM have been studied deeply.But the pathogenesis and cause of HCM are not clear. [objective] to study the expression of TGF- 尾 _ 1TGF- 尾 _ 2 and TGF- 尾 _ 3 in myocardium of patients with hypertrophic cardiomyopathy (HCM), and compare with the control group, and compare the expression of TGF- 尾 _ 1TGF- 尾 _ 2 and TGF- 尾 _ 3 in hypertrophic cardiomyopathy.[methods] Myocardial tissues of 56 patients with hypertrophic cardiomyopathy and 18 healthy controls were selected for the diagnosis of hypertrophic cardiomyopathy by forensic pathology.Routine HE staining and immunohistochemical method were used to detect the expression of TGF 尾 1TGF- 尾 2TGF- 尾 3, and the results were judged by image analysis system.Myocyte hypertrophy, vacuolar degeneration and lipofuscin deposition were observed in some patients, accompanied by a small number of inflammatory cells infiltration and myocardial interstitial edema, obvious fibrosis, diversity of nuclei and abnormal nuclei.In the healthy control group, the myocardial fibers were arranged neatly, the striations were clear, and the myocardial cells were normal.The mean gray value of the expression of TGF- 尾 1 TGF- 尾 2TGF- 尾 3 in hypertrophic cardiomyopathy was 120.86 卤11.73122.98 卤9.55115.21 卤7.92.21 卤7.92TGF- 尾 _ 2TGF- 尾 _ 3 in healthy controls was 36.00 卤5.31 29.84 卤4.85 卤29.92 卤TGF- 尾 _ 2TGF- 尾 _ 3 in hypertrophic cardiomyopathy and the expression of TGF- 尾 _ (2) TGF- 尾 _ 3 in hypertrophic cardiomyopathy was 36.00 卤5.31 ~ 29.84 卤4.85 卤29.92 卤6.80.TGF 尾 _ 2TGF- 尾 _ 3 respectively.All of them were higher than those in the healthy control group.The difference was statistically significant (P 0.05). [conclusion] this study shows that TGF- 尾 isomer TGF- 尾 _ 1 / 2 ~ (3) plays an important role in the occurrence and development of myocardial fibrosis in hypertrophic cardiomyopathy, and provides a possible objective index for the diagnosis of hypertrophic cardiomyopathy by forensic pathology.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R542.2

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