胶原纤维、Ⅳ型胶原及CD34诊断外伤性迟发性脾破裂

外伤性迟发性脾破裂的鉴定难点在于准确判断脾破裂与腹部受到外力事件之间是否存在直接延续的因果关系。经典的组织病理检查的结果虽然具有十分重要的作用,但存在假阴性的可能,因此需要寻找其他辅助诊断指标。本文通过一例明确的外伤性迟发性脾破裂病例,在损伤及正常脾组织中,利用HE染色、Masson染色、免疫组化染色,针对胶原纤维、Ⅳ型胶原、CD34三个指标进行组织形态学对比,并量化免疫组化结果。HE染色发现出血灶周围已经形成了肉芽组织;Masson染色发现出血区周围的胶原纤维密度明显高于远端正常组织,且形成包膜状纤维结构;免疫组化结果发现,出血区域的Ⅳ型胶原及CD34相比正常对照组织均呈强阳性,平均光密度具有统计学差异。在判断脾损伤后经过时间方面,HE染色判断为7~14d,Masson染色判断其大于6d,免疫组化判断为7~14d,三者结果基本一致。说明HE染色、Masson染色以及Ⅳ型胶原和CD34免疫组化染色均可获得较为准确的结果。与HE染色相比,胶原纤维、Ⅳ型胶原、CD34更为直观并易于识别判断,这为今后此类案件的鉴定提供了新的辅助指标。

Role of Collagen Fiber,Collagen Ⅳ and CD34 in Diagnosing Delayed Traumatic Spleen Rupture

Whether there is a direct causal relationship between spleen rupture and accidental abdominal injury is difficult to judge for the identification of traumatic delayed splenic rupture. The approach of classic histopathologic examination, albeit important, lies in possibility of false negative. Thus, the auxiliary diagnostic indicators are helpful and worth seeking. This article deals with a case that has been unambiguously identified as the delayed traumatic splenic rupture. With the damaged and normal(for control) spleen tissues, the manipulations were conducted through the respective HE(hematoxylin-eosin), Masson and immunohistochemical staining to have the three indicators of collagen fiber, collagen Ⅳ and CD34 unveiled, therefore making the histological conformation compared together with the quantification of immunohistochemical results. HE staining showed that exuberant granulation had formed around the hemorrhagic foci. Masson staining revealed that the density of collagen fibers was significantly higher around the bleeding area than that of the normal tissue at the distal end, displaying a capsule-like fibrous structure. Immunohistochemical results demonstrated that both the collagen Ⅳ and CD34 were strongly positive throughout the bleeding area when compared with the normal control, exhibiting statistically difference between their average optical densities. On the elapsing time from the injury of spleen, both the HE staining and immunohistochemical results gave 7~14 days, with the Masson’s being not fewer than 6 days, manifesting the roughly same estimation among the three of them for delivery of a comparatively accurate determination. Compared with HE staining, more intuitive and easy-torecognize results are those indications from collagen fiber, collagen Ⅳ and/or CD34, hence the three substances are eligible for the new auxiliary index/indicator into identification of related cases in the future.