本文選題：C-反應(yīng)蛋白(CRP) + 冠心病猝死��； 參考：《華中科技大學(xué)》2006年碩士論文

【摘要】： [目的]冠心病猝死(sudden coronary death, SCD)的病理診斷一直是法醫(yī)病理學(xué)的重要研究課題之一,多年來,國內(nèi)外研究人員對此進(jìn)行了大量探討。SCD發(fā)生的病理基礎(chǔ)是冠狀動(dòng)脈(以下簡稱冠脈)粥樣硬化,但是由于SCD發(fā)生迅速、多發(fā)生在院外,且肉眼觀察和常規(guī)組織學(xué)切片H.E.染色鏡檢很難發(fā)現(xiàn)明顯的病理形態(tài)學(xué)改變,所以一直到現(xiàn)在,法醫(yī)學(xué)檢案仍然延續(xù)常規(guī)的排他性診斷,而未找到SCD診斷的“金標(biāo)準(zhǔn)”。傳統(tǒng)研究的注意力多集中在早期心肌缺血和心肌缺血再灌注損傷等方面。上世紀(jì)70年代研究者發(fā)現(xiàn)了血清炎癥反應(yīng)標(biāo)志物C-反應(yīng)蛋白(C-reactive protein, CRP)、白介素(interleukin, IL)、腫瘤壞死因子(tumor necrosis factor, TNF)等一批炎癥相關(guān)因子后,一些學(xué)者對于冠心病(coronary heart disease, CHD)發(fā)生的傳統(tǒng)定義——脂質(zhì)沉積過程才有所置疑。1999年Ross第一次明確提出“動(dòng)脈粥樣硬化是一種炎性疾病”的假說,認(rèn)為動(dòng)脈粥樣硬化(atherosclerosis, AS)不僅僅是脂質(zhì)沉積過程,而是由炎癥貫穿了AS發(fā)生發(fā)展的全過程。之后大量研究圍繞炎癥與AS的關(guān)系展開,有學(xué)者研究發(fā)現(xiàn)CRP水平的升高和急性冠脈綜合征的發(fā)生密切相關(guān)。但SCD者冠脈粥樣硬化斑塊內(nèi)的CRP表達(dá)情況尚未見報(bào)道。為此,我們應(yīng)用免疫組化和圖像分析技術(shù)來定性和半定量檢測CRP在SCD者冠脈粥樣硬化斑塊內(nèi)表達(dá)的變化,以探討其作為死后SCD診斷指標(biāo)的意義。 [方法]從本教研室2001～2004年法醫(yī)病理學(xué)尸檢檔案中挑選從死亡時(shí)間至尸檢時(shí)間在48小時(shí)以內(nèi)的案例共68例,并搜集其原始檔案資料及其心臟標(biāo)本、蠟塊和H.E.切片。分為A組(SCD組,實(shí)驗(yàn)組)、B組(CHD非心臟性疾病死亡組,對照組Ⅰ)和C組(無明顯冠脈粥樣硬化組,對照組Ⅱ)三組。選擇病例的標(biāo)準(zhǔn)是:三組均排除細(xì)菌感染、病毒感染、急慢性炎癥、腫瘤及免疫性疾病。A組和B組每例冠脈的左前降支(left anterior descending, LAD)和右主支(right main, RM)內(nèi)膜AS斑塊病變達(dá)3級或3級以上,而不考慮另外兩個(gè)分支左主干(left main, LM)和左旋支(left circumflex, LC)有無病變及其等級;C組冠脈四個(gè)分支均無明顯粥樣硬化病變或僅有1級的輕度病變。A組排除暴力死及其它疾病所致的死亡,明確診斷為SCD,其猝死時(shí)間按WHO標(biāo)準(zhǔn),從癥狀發(fā)作到死亡時(shí)間在24小時(shí)內(nèi);B組、C組的死亡原因是暴力死或非心臟性疾病(如腦出血、中毒、機(jī)械性窒息、機(jī)械性損傷等)所致。運(yùn)用免疫組化染色技術(shù)SABC法和圖像分析技術(shù),對三組冠脈粥樣硬化斑塊內(nèi)CRP表達(dá)情況進(jìn)行定性、半定量檢測和統(tǒng)計(jì)學(xué)分析。 [結(jié)果] A組27例,其中,男20例,女7例;年齡30～74歲,平均50.30歲;從死亡到尸檢時(shí)間為48h以內(nèi);冠脈粥樣硬化斑塊病變4級22例,3級5例;心重220g～510g,平均388.22g。B組21例,其中,男18例,女3例;年齡35～81歲,平均52.19歲;冠脈粥樣硬化斑塊病變4級8例,3級13例;心重220g～495g,平均379.29g;死因?yàn)橥鈧阅X出血8例,中毒4例,機(jī)械性窒息1例,機(jī)械性損傷1例,病理性腦出血3例,主動(dòng)脈夾層破裂1例,腦水腫、腦疝形成1例,肺脂肪栓塞1例,腦梗死1例。C組20例,其中,男12例,女8例,年齡17～42歲,平均28.70歲;心重210g～350g,平均293.50g,冠脈內(nèi)膜未見增厚者2例,輕度增厚1級者18例;死因?yàn)槟X外傷5例,中毒4例,電擊1例,機(jī)械性損傷3例,機(jī)械性窒息1例,肺脂肪栓塞1例,肺羊水栓塞4例,癲癇發(fā)作1例。免疫組織化學(xué)染色:A組27例中,21例強(qiáng)陽性表達(dá),6例出現(xiàn)較強(qiáng)陽性表達(dá); B組21例中,3例較弱陽性表達(dá),11例出現(xiàn)微弱陽性表達(dá),7例未見陽性表達(dá);C組冠脈內(nèi)膜及輕度增厚處未見CRP陽性反應(yīng)。經(jīng)圖像分析檢測并進(jìn)行統(tǒng)計(jì)分析結(jié)果表明,SCD組與對照組Ⅰ冠脈粥樣硬化斑塊中CRP表達(dá)的OD值和R值的差異有顯著性意義(P 0.01),與對照組Ⅱ相比,其冠脈粥樣硬化斑塊中CRP表達(dá)的OD值和R值的差異也有顯著性意義(P 0.01);而兩對照組間冠脈粥樣硬化斑塊中CRP表達(dá)的差異無顯著性意義。 [結(jié)論] SCD組冠脈粥樣硬化斑塊中CRP表達(dá)呈陽性,其表達(dá)的OD值和R值與兩個(gè)對照組相比的差異有顯著性意義;認(rèn)為這種差異可能與SCD的發(fā)生有一定的關(guān)系;其冠脈粥樣硬化斑塊中CRP的表達(dá)情況,可作為SCD者死后法醫(yī)病理學(xué)診斷的一個(gè)有用指標(biāo)。
[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.
【學(xué)位授予單位】：華中科技大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2006
【分類號】：D919

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