大鼠實(shí)驗(yàn)性腦梗死早期CT值及GFAP表達(dá)的動(dòng)態(tài)研究
發(fā)布時(shí)間：2019-07-01 17:31
【摘要】： 【研究背景】腦梗死病例在法醫(yī)學(xué)活體鑒定和臨床神經(jīng)科中并不少見,患者往往遺留較嚴(yán)重的后遺癥狀。因其發(fā)病原因既可以是病理性的也可以由外傷所致,所以鑒別腦梗死發(fā)病過程中傷與病的關(guān)系是正確評價(jià)外傷后腦梗死患者損傷程度的前提。同時(shí),如何科學(xué)認(rèn)定也是法醫(yī)學(xué)工作者的重要任務(wù)。在多個(gè)鑒別因素中,我們認(rèn)為腦梗死的發(fā)生時(shí)間是鑒別傷與病的關(guān)鍵因素之一。因梗死后腦組織發(fā)生水腫,在CT上可表現(xiàn)出腦梗死區(qū)域的低密度灶。因此,目前CT在臨床上已經(jīng)成為腦梗死首選的檢查手段,也成為臨床法醫(yī)鑒定中診斷腦梗死的重要依據(jù);另外,膠質(zhì)纖維酸性蛋白(glial fibrillouy acidic protein, GFAP)是星形膠質(zhì)細(xì)胞的標(biāo)志,也是研究腦損傷病理形態(tài)變化和推斷損傷時(shí)間的標(biāo)志分子之一。但是目前對于腦梗死后CT值及GFAP表達(dá)變化的動(dòng)態(tài)研究還很少,所以,探討上述兩項(xiàng)指標(biāo)在腦梗死后的變化規(guī)律就成為本研究的核心內(nèi)容。 【目的】從影像學(xué)、病理形態(tài)學(xué)及分子水平探討腦梗死的變化規(guī)律,以間接推測腦梗死發(fā)生的時(shí)間。為臨床法醫(yī)檢案中正確的判斷腦梗死與外傷的關(guān)系提供有力的依據(jù)。 【材料與方法】Wistar成年大鼠55只,雌雄不拘。分為11組,每組5只,分別為對照組、假手術(shù)組和實(shí)驗(yàn)組。其中對照組1組,假手術(shù)組按處死時(shí)間分為3h、6h和12h三組,實(shí)驗(yàn)組按傷后分別飼養(yǎng)存活2h、3h、4h、6h、8h、12h、24h分為七組,復(fù)制成永久性大腦中動(dòng)脈梗死動(dòng)物模型。同期行大鼠大腦冠狀CT掃描,記錄CT值,并請有經(jīng)驗(yàn)的放射科醫(yī)生盲法閱片。CT掃描后灌流固定,腦組織取材切片,HE染色觀察形態(tài)學(xué)的改變,免疫組化方法檢測GFAP的表達(dá)水平。對梗死后腦組織CT值及GFAP表達(dá)變化與損傷時(shí)間的關(guān)系進(jìn)行分析,并與傷后不同時(shí)相的病理變化進(jìn)行對比。 【結(jié)果】實(shí)驗(yàn)組大鼠腦梗死后2h,全部動(dòng)物CT掃描均未發(fā)現(xiàn)明確的梗死灶,3h組有2只動(dòng)物發(fā)現(xiàn)梗死灶,界限不清。至6h全部動(dòng)物均出現(xiàn)明確梗死灶。且自3h后大腦中動(dòng)脈供血區(qū)腦組織出現(xiàn)不同程度的低密度,隨著時(shí)間的推移,密度逐漸降低。腦梗死兩側(cè)CT值的差值逐漸增大。且其差值與梗死時(shí)間呈顯著直線正相關(guān)(相關(guān)系數(shù)r=0.967,P0.05,回歸方程:Y=0.158+0.58X)。即梗死時(shí)間每增加1h,健、患兩側(cè)CT值的差值平均增加0.738HU。腦梗死后24h內(nèi),腦組織經(jīng)歷缺血、變性、壞死伴腦水腫,神經(jīng)元及神經(jīng)纖維破裂,細(xì)胞核固縮、溶解等一系列改變。梗死后3h腦白質(zhì)已出現(xiàn)水腫及核固縮表現(xiàn),但程度較輕,呈灶狀;梗死后6h,腦白質(zhì)水腫及核固縮程度加重;梗死后12h,細(xì)胞核固縮、核溶解、組織疏松校明顯;到梗死后24h,核固縮、核溶解十分明顯,組織疏松十分明顯。同時(shí),GFAP的表達(dá)隨腦梗死的時(shí)間延長也發(fā)生規(guī)律性的變化。正常腦組織中,GFAP陽性反應(yīng)較低,細(xì)胞體積較小,突起纖細(xì)。腦梗死后6h,星形膠質(zhì)細(xì)胞主要局限于梗死區(qū)周圍,GFAP陽性反應(yīng)增加,染色加深,突起增多。梗死后12h,星形膠質(zhì)細(xì)胞胞體肥大,GFAP陽性細(xì)胞面積百分比明顯增加。梗死后24h,星形膠質(zhì)細(xì)胞波及全腦,GFAP陽性細(xì)胞面積百分比持續(xù)增大。 【結(jié)論】腦梗死后腦組織水腫是導(dǎo)致CT值較健側(cè)降低的主要病理基礎(chǔ),隨梗死時(shí)間的延長,梗死區(qū)域腦組織水腫程度逐漸加重是導(dǎo)致CT值進(jìn)行性下降的重要原因。GFAP是研究腦損傷病理形態(tài)變化和推斷損傷時(shí)間的標(biāo)志分子之一。健、患側(cè)CT值的差值及GFAP的表達(dá)均顯示出顯著的時(shí)間相關(guān)性。腦梗死后至少6小時(shí)才可以從所有動(dòng)物CT圖像上觀察到明確的梗死灶,且隨梗死時(shí)間的延長,梗死灶的密度逐漸降低,面積逐漸增大。這些對于法醫(yī)學(xué)上正確運(yùn)用CT圖像初步估計(jì)腦梗死的發(fā)生時(shí)間及掌握鑒定時(shí)機(jī)有明確的指導(dǎo)性,也為腦梗死的進(jìn)一步影像學(xué)研究提供了依據(jù)。同時(shí),腦梗死后形態(tài)學(xué)的變化及GFAP的表達(dá)也與梗死時(shí)間有相關(guān)性,這些不僅為正確理解腦梗死病理基礎(chǔ)和進(jìn)一步的病理學(xué)研究提供了重要的依據(jù),也從分子水平為法醫(yī)學(xué)鑒定中梗死時(shí)間推斷、鑒定時(shí)機(jī)的掌握等提供了依據(jù)。
[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.
【學(xué)位授予單位】：華中科技大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2006
【分類號(hào)】：D919
本文編號(hào)：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.
【學(xué)位授予單位】：華中科技大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2006
【分類號(hào)】：D919
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