本文選題：法醫(yī)病理學(xué)　切入點(diǎn)：冠心病　出處：《山西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:研究冠心病猝死者心肌中腦利鈉肽前體(proBNP)及心血中氨基末端腦利鈉肽前體(NTproBNP)和可溶性ST2(sST2)的表達(dá)變化,探討proBNP、NTproBNP、sST2在法醫(yī)學(xué)實(shí)踐中診斷冠心病猝死及心肌缺血嚴(yán)重程度的應(yīng)用價(jià)值。方法:選取山西醫(yī)科大學(xué)司法鑒定中心2011-2016年尸檢案例標(biāo)本共60例,分為冠心病猝死組、單純冠脈狹窄組及正常對(duì)照組,每組各20例。每個(gè)案例取左心室前壁及左心室后壁各一塊及右心血樣本10ml。運(yùn)用免疫組織化學(xué)染色、Western印跡法檢測(cè)心肌樣本中proBNP的表達(dá);采用RT-qPCR技術(shù)檢測(cè)心肌中BNPmRNA的表達(dá);采用ELISA法檢測(cè)血漿中NTproBNP和sST2的含量。結(jié)果:(1)冠心病猝死組、單純冠脈狹窄組心肌組織中proBNP免疫組化染色均為陽(yáng)性染色,正常對(duì)照組未見明顯陽(yáng)性染色。(2)冠心病猝死組、單純冠脈狹窄組心肌組織proBNP蛋白相對(duì)表達(dá)量高于正常對(duì)照組,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。(3)冠心病猝死組、單純冠脈狹窄組心肌組織內(nèi)BNPmRNA相對(duì)表達(dá)量較正常對(duì)照組明顯升高,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。(4)冠心病猝死組、單純冠脈狹窄組血漿內(nèi)NTproBNP的含量較正常對(duì)照組明顯升高;冠心病猝死組、單純冠脈狹窄組及正常對(duì)照組NTproBNP數(shù)據(jù)兩兩比較,表達(dá)差異均具有統(tǒng)計(jì)學(xué)意義(P0.05)。(5)冠心病猝死組、單純冠脈狹窄組血漿內(nèi)sST2的含量較正常對(duì)照組明顯升高,冠心病猝死組、單純冠脈狹窄組及正常對(duì)照組sST2數(shù)據(jù)兩兩比較,其差異均具有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:(1)心肌缺血時(shí)心肌組織proBNP表達(dá)升高,proBNP可作為判斷心肌缺血及冠心病猝死輔助指標(biāo)。(2)測(cè)定血漿中NTproBNP和sST2有助于鑒別冠心病的嚴(yán)重程度及是否為冠心病猝死;聯(lián)合檢測(cè)proBNP、NTproBNP、sST2對(duì)冠心病猝死的診斷更具優(yōu)勢(shì)。
[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.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：D919

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