肾脏组织肌红蛋白检测在法医病理诊断中的应用价值

应用免疫组化方法,对49例被尸检的人肾组织进行肌红蛋白检测,其中生前有广泛软组织损伤的损伤组22例,冠心病猝死组15例,并用12例无上述病史的人肾脏组织作对照.结果显示损伤组有8例(8/22)远曲小管及集合管管腔内管型呈肌红蛋白阳性或强阳性;冠心病猝死组有3例皮质肾小管内管型呈阳性;对照组均为阴性.说明肾肌红蛋白检测对挤压综合征(crushsyndrome,CS)死后诊断有重要价值.     

15例挤压综合征死亡的法医病理学研究

对 15例挤压伤后挤压综合征的致伤原因、损伤经过时间及尸检材料进行分析,并采用组织学和免疫组化 ABC法染色,观察肾脏的病理改变特点。结果发现：肾脏肿大,肾小管上皮细胞变性、坏死,远曲小管扩张,内有蛋白管型、细胞管型,并证实有肌红蛋白管型存在。     

挤压伤——挤压综合征的实验病理学研究

观察挤压伤后挤压综合征的发生发展过程及肾脏病理改变特点。以家兔制造挤压伤—挤压综合征的动物模型 ,取血和尿进行生化检验并应用光镜、电镜及免疫组化等方法 ,观察肾脏的形态学改变。结果显示 :(1)挤压伤后血K+和血BUN明显升高 ,血CO2 CP明显下降 (P <0 0 5 ) ;(2 )在挤压综合征时 ,肾脏肾小球肿胀 ,肾小管上皮细胞不同程度的变性坏死 ,管腔内有以肌红蛋白为主要成分的管型 ,血BUN持续下降 ,血K+改变不明显。肾小管上皮细胞的变性坏死及肾小管内肌红蛋白管型形成可作为挤压综合征的法医病理学诊断依据之一 ,血K+升高是挤压伤后急性死亡的原因之一     

肌红蛋白染色在挤压综合征法医学鉴定中的应用

通过对软组织损伤后出现典型挤压综合征和其它原因死亡案件的分析,探讨检测肌红蛋白对挤压综合征的诊断价值。认为挤压综合征的诊断应从大面积软组织损伤史和急性肾功能衰竭的病理检验入手,肾小管内管型物质的肌红蛋白免疫组织化学染色作为证据之一,而非唯一依据。     

广泛软组织挫伤后器官形态学的研究

目的探索法医病理学诊断广泛软组织挫伤、挤压综合征致死案例的形态学改变。方法采用大鼠广泛软组织挫伤模型和人体挤压综合征致死标本,对器官进行HE染色、肾肌红蛋白HSP免疫组化染色及电镜观察。 结果肾肌红蛋白的阳性率分别为60％、75％、95％;心肌、脑组织阳性染色率为90％;广泛软组织挫伤短期内死亡的大鼠肾电镜观察,可见多种组织细胞病理改变致使毛细血管腔狭窄、闭塞等。结论建立了较理想的大鼠广泛软组织挫伤形成的挤压综合征动物模型;为此类研究积累了具有一定实用价值的病理形态学资料。     

ABC—Mb法诊断挤压综合征一例

<正> 挤压综合征致死,在法医尸检工作中较常见。对其尸检诊断,常规方法有时有一定程度的困难,ABC法能确证肾脏内肌红蛋白管型的存在。本文对一例常规方法诊断有分歧的尸检,采用ABC抗肌红蛋白法(ABC—Mb法)观察到肾小管内有肌红蛋白管型,现报告如下。男,23岁,某日晚捆绑在一树干上,被棍棒、拳脚、树条打击全身,其间昏迷四次,曾叫口渴,8小时后入当地医院,见面部,颈前后,胸腹,双臀及会阴、四肢皮肤青紫肿胀,     

挤压综合征致死一例探讨

挤压综合征,又称为挤压性肾衰综合征,是指在挤压伤(大多为四肢,肌肉丰富部位)的基础上并发休克、肌红蛋白尿,代谢性酸中毒、高血钾、氮质血症和急性肾衰的一组临床症候群.发生挤压综合征有两个关键因素:1.伤后肌肉缺血、坏死,大量毒性产物(如肌红蛋白、钾离子、组织分解产物等)释出致代谢紊乱,全身中毒.2.肾脏缺血导致急性肾功能衰竭.本症在法医检案中并非罕见,特报导一个曾经有过争议的实例并进行探讨.     

肌红蛋白及其法医学意义探讨

自1944年Bywaters和Beall提出创伤后肾功能衰竭与肌红蛋白之间的关系后，临床上一直将肌红蛋白尿（myoglobinuria）作为诊断挤压综合征（crushsgn·drome）最具价值的指标之一l’l。在法医学实践中，也常将肾组织肌红蛋白管型的组织化学染色阳性作为判断挤压综合征、甚至死因的主要依据。随着研究的深入，近年来有不少报道提出，外伤不是导致肌红蛋白尿或肾组织肌红蛋白管型阳性的唯一因素【’，’］。为此，就肌红蛋白及其法医学意义作一综述，供同行们参考。！肌红蛋白的一般特性以及正常人体非肌组织肌红蛋白的含量肌红蛋白（mpOglobil…     

广泛性软组织挫伤致死37例分析

对37例广泛性软组织挫伤的面积、程度、死亡时间以及死亡后内脏器官的病理组织学变化进行观察和分析 ,认为 :广泛性软组织损伤后死亡的尸体损伤面积愈大、程度愈重其死亡的时间愈短 ;24h以后死亡的尸体 ,肾脏的损害方始出现 ;典型的挤压综合征的症状、体征及组织学改变应在48h以后甚至更长的时间出现     

广泛软组织挫伤致挤压综合征1例

挤压综合征是指遭受挤压伤的人在挤压解除后,出现以肌红蛋白尿和急性肾功能衰竭为主要特征的临床症候群[1]。挤压综合征虽可见于多种原因,但法医检案中遇到最多的是肢体广泛软组织挫伤和肢体被持续较长时间捆绑[1]。作者曾遇1例直接打击肢体所致挤压综合征的案例,现报道如下。1     

成人肾脏ABO组织血型1-4型糖链H物质的分布

目的观察1型H、2型H及3/4型H糖链在成人肾组织中的分布及其与分泌状态的关系。方法 应用抗ABO抗体及3种糖链特异的单克隆抗H抗体的免疫组织化学方法,检查分泌型与非分泌型个体肾组织中相应抗原物质的分布。结果 在分泌型和非分泌型人的肾远曲小管均表达2型H和3/4型H物质,1型H和3/4型H物质只在分泌型人肾集合管表达,在非分泌型人中不表达。另外集合管的2型H物质的表达与分泌状态无关。结论 人肾组织有ABH物质的表达,不同肾组织细胞表达的H物质结构差异与AB0型分泌状态有关。     

The effect of lethal electrical shock on postmortem serum myoglobin concentrations

Postmortem serum myoglobin concentrations in blood from the femoral vein (peripheral withdrawal) and the heart (central withdrawal) of nine electrical fatalities were compared with those of 74 individuals who had died of other causes. Independent of the cause of death or topographical site, serum myoglobin concentrations rose dramatically with the passage of postmortem time (maximum concentrations in the control group: 975,100 micrograms/l). In 59% of the total sample (electrical fatalities plus controls), serum myoglobin concentrations were higher in the central blood, in the other 41% the concentrations were higher in the peripheral blood. The differences in concentrations between the peripheral and the central withdrawal area correlated with neither the postmortem interval nor the cause of death. Up to the second day postmortem there was a statistically significant difference in serum myoglobin concentrations between electrical fatalities and controls. The individual values within each group, however, varied widely and overlapped between groups. Controls who had also suffered muscle injury (polytrauma, myocardial infarction) did not have significantly higher serum myoglobin concentrations than controls without muscle injury. Myoglobin concentrations appear to be greatly influenced by the extent and duration of the muscle cramps induced by the electrical current. Correct interpretation of serum myoglobin concentrations depends on the knowledge of events surrounding the lethal electrical shock. Postmortem determination of serum myoglobin concentrations alone is, therefore, not sufficient to establish intravital exposure to electrical current and can aid the diagnosis only in special cases.     

Immunohistochemical investigation of ubiquitin and myoglobin in the kidney in medicolegal autopsy cases

We examined the immunohistochemical distributions of ubiquitin (Ub) and myoglobin (Mb) in human kidney tissues to assist the pathological assessment of death due to trauma. Medicolegal autopsy cases at our institute (n=138: 0-96 years of age, 105 males and 33 females) were examined. Causes of death were blunt injury (n=31), sharp injury (n=15), poisoning (n=11), drowning (n=10), fire fatalities (n=25), hypothermia (n=7), asphyxiation (n=14), hyperthermia (n=3), and natural diseases (n=22) for controls. Immunostaining of Ub and Mb was performed on the formalin-fixed paraffin-embedded kidney tissue sections. Quantitative analyses by estimating the proportion of Ub- and Mb-positive cells (%positivity) of renal tubule epithelial cells showed that the positivities for Ub and Mb were higher in subjects who died due to fire, blunt injury, sharp injury and fatal hypothermia than in other groups. The Ub-positivity correlated with the severity of airway thermal injury in fire deaths, survival time in blunt injury, and serum markers for renal failure in deaths due to sharp injury. Concomitant increases in the tubular Mb- and Ub-positivities were characteristic to deaths from injury and hypothermia. These findings suggest that Ub may serve as a sensitive indicator of the fatal influence of traumas.     

急性吗啡中毒大鼠主要器官内吗啡的免疫组化定位研究

一次静脉注射１２．５ｍｇ／ｋｇ。ｂｗ的盐酸吗啡染毒雄性Ｓ－Ｄ大鼠，２小时后处死，取其脑、肾、肝、肺、心组织以２％戊二醛和４％多聚甲醛混合液固定后，常规石蜡切片。运用抗吗啡抗血清及ＳＡＢＣ技术染色。结果显示上述组织切片有不同程度的阳性染色，阳性着色主要见于肾髓质部分肾小管上皮细胞，肝脏中央静脉周围的肝细胞、肺泡上皮细胞及肺内小支气管粘膜上皮细胞、中脑部分神经细胞、室管膜细胞、心肌细胞．以及各器官小血管及毛细血管内皮细胞胞浆、血浆及肾小管腔内尿液。     

Prevalence of rhabdomyolysis in drug deaths

Rhabdomyolysis has repeatedly been reported as a possible consequence of illicit drug consumption especially in clinical literature. In order to investigate the prevalence of rhabdomyolysis in cases of drug deaths, immunohistochemical staining of kidney sections with a myoglobin antibody was performed at 103 consecutive fatal drug poisonings. The control group consisted of 107 unselected forensic autopsies. With regard to the presence of intratubular myoglobin, 33% of the study group were categorized as "strongly positive", 17.5% as "slightly positive" and 49.5% as "negative". No single substance showed a particularly high incidence of rhabdomyolysis nor were there correlations to special combinations of substances. In the control group a "strongly positive" result after myoglobin staining was observed in only 10.3% of 107 cases, a "slightly positive" result in 13.1% and a "negative" result in 76.6%. The findings suggest that rhabdomyolysis is a frequent consequence of illicit drug consumption and that it is not promoted by a single factor, but by a combination of several factors.     

The effect of electricity on the myoglobin content of the human heart and skeletal muscles

The myoglobin content of heart muscles was examined by the indirect immunoperoxidase method in eight autopsy cases where death was due to electricity. Seven cases showed a considerable release of myoglobin from the myocardial fibers. In experimental comparison, the heart muscles and skeletal muscles from nine cases where death was natural were exposed to electricity, and considerable deletion of myoglobin was also demonstrated. We believe that the findings of ischemia or thermal effects due to electricity were the cause of the release of myoglobin. Because the demonstration of myoglobin is preferable to estimation of the damaged areas of muscles by hematoxylin-eosin staining, this examination may be more advantageous in forensic examination of death by electricity.     

20例脂肪栓塞死亡的法医学分析

目的分析脂肪栓塞综合征（fatembolismsyndrome,FES）死亡的一般情况以及法医病理学特点,为此类案件的法医病理学鉴定提供参考。方法选取某大学法医学鉴定中心1999—2012年20例FES死亡案件．对其一般情况及法医病理学特点（包括致伤方式、损伤类型、临床表现、病理学改变等方面）进行总结。结果脂肪栓塞主要见于损伤导致的长骨骨折和全身大面积软组织损伤,主要类型为肺脂肪栓塞,偶见合并脑脂肪栓塞。症状多出现在伤后和术后较短时间内,组织病理学检查可在肺小血管内检见大量脂滴并经特殊染色证实。结论FES死亡案例在损伤类型、脂肪栓塞出现症状时间及组织病理学表现等方面均有一定规律和特点。在鉴定中应注意进行特殊染色（油红0染色）处理,寻找FES的直接证据。