VEGF免疫组化染色在冠心病猝死诊断中的应用

运用免疫组化SABC法和图像分析与统计学处理系统 ,对16例冠心病猝死和15例非冠心病猝死对照组尸检心脏标本心肌局部血管内皮生长因子 (VEGF)的表达进行了研究。结果 :16例冠心病猝心脏标本心肌梗死局部心肌均有VEGF的阳性表达 ,尤以心肌梗死灶边缘为甚 ,阳性表达率为100 %。15例非冠心病猝死对照组心脏标本仅有2例心肌局部散在有VEGF弱阳性表达 ,其余为阴性。将免疫组化染色结果进行图像定量分析与统计学处理 ,冠心病猝死组阳性指数为13.68±2.73 ,对照组为2.05±0.84 ,两组结果有极显著性差异 (P<0.01)。本研究结果提示 ,VEGF免疫组化染色可望为冠心病猝死的死后诊断提供一个比较客观的病理形态学依据     

Functional morphology of the hypothalamo-hypophyseal-adrenal system in acute coronary failure]

Histological and morphometric studies of large-cell and small-cell hypothalamic nuclei, adenohypophysis, and adrenal cortex of patients who died from acute coronary failure revealed signs of persistent hyperfunction of small-cell nuclei of the hypothalamus, bundle and retinal adrenocortical zones, and signs of short-term hyperfunction of pituitary adenocytes. These changes indicate disorders in the hypothalamic regulation of adrenal activity.     

柯萨奇病毒和腺病毒受体在VMC和DCM猝死者心肌组织中的表达

目的探讨病毒性心肌炎(VMC)和扩张性心肌病(DCM)的发病机制及相互关系。方法应用改良免疫组化技术检测病毒性心肌炎(28例)、扩张性心肌病(31例)和对照组19例。结果CAR阳性表达为棕色,主要表达于心肌细胞膜。在VMC心肌中均检测到较高水平的CAR表达(免疫组化面积积分为4.3975±0.0365);DCM组26例心肌组织中有较高水平的CAR表达(4.2064±0.0526),有5例几乎无表达(0.0723±0.0014),对照组心肌中几乎未检测到CAR的表达(0.0731±0.0362),VMC组及DCM组与对照组比较差异有显著性(P<0.05)。结论VMC和DCM心肌组织中CAR表达明显高于对照组,提示VMC和DCM的发病都有病毒感染的参与,两者可能来自同一个病因。     

冠心病猝死心肌mcl-1蛋白检测及其意义

目的观察冠心病猝死(SCD)心肌mcl-1蛋白产物,探讨其免疫组化检测及其对SCD诊断的意义。方法运用免疫组织化学SABC法,对46例SCD和40例非猝死心肌(有冠心病和无冠心病)中mcl-1蛋白产物进行检测和观察,并比较其差异。结果(1)自症状出现至死亡,时间超过30min的SCD(36例),其心肌组织均出现mcl-1蛋白阳性染色;(2)自症状出现至死亡,时间短于30min的SCD(10例),其心肌组织mcl-1蛋白呈弱阳性染色;(3)冠心病非猝死样本(20例),4例心肌出现微弱的mcl-1蛋白阳性染色,无冠心病非猝死样本(20例)几乎没有出现阳性染色。结论心肌mcl-1蛋白的免疫组化检测可诊断自症状出现至死亡时间超过30min的SCD。     

Unexpected infant death attributable to cardiac tumor or cardiomyopathy. Immunohistochemical and electron microscopical findings in three cases

The pathological findings, including immunohistochemical and electron microscopical findings, in three infants who died unexpectedly of cardiac tumor or cardiomyopathy are reported. The first was a 13-month-old boy with tuberous sclerosis and multiple rhabdomyomas of the heart, who presented with a postpartal cardiac murmur and moderate cardiomegaly. The further history was unknown. The rhabdomyoma nodules were composed of spider cells containing small amounts of desmin and myosin as well as isolated myofibrils. Microscopically small glioma nodules contained high amounts of GFAP. The second case, a boy 4 months of age, died of a large benign fibrous histiocytoma of the heart after an uneventful history. Tumor cells contained alpha-1-anti-chymotrypsin and lysozyme. The third case, a girl 2 months of age, died unexpectedly of histiocytoid cardiomyopathy. The affected cells contained fat droplets, glycogen granules, many leptomer myofibrils and small amounts of myosin and desmin.     

Adverse mental health outcomes associated with emotional abuse in young rural South African women: a cross-sectional study

There is a lack of data on the prevalence of emotional abuse in youth. The aim of this study was thus to estimate the prevalence of emotional abuse in intimate partnerships among young women in rural South Africa and to measure the association between lifetime experience of emotional abuse (with and without the combined experience of physical and/or sexual abuse) and adverse health outcomes. Between 2002 and 2003, young women from 70 villages were recruited to participate in the cluster randomized controlled trial of an HIV behavioral intervention, Stepping Stones. Data was obtained through the administration of a questionnaire at baseline. Of the 1,293 women who had ever been partnered, 189 (14.6%) had experienced only emotional abuse in their lifetimes. Three hundred sixty-six women (28.3%) experienced emotional abuse with physical and/or sexual abuse in their lifetimes, and one hundred forty-four women (11.1%) experienced physical and/or sexual abuse without emotional abuse. Hazardous drinking was associated with the experience of physical and/or sexual abuse, with (OR 6.0, 95% CI [1.0, 36.6]) and without emotional abuse (OR 5.8, 95% CI [1.1, 29.4]). Illicit drug use (OR 5.6, 95% CI [2.4, 12.6]), having depressive symptoms (OR 2.9, 95% CI [1.2, 4.2]), having psychological distress (OR 1.9, 95% CI [1.4, 2.6]), and suicidality (OR 79.0, 95% CI [17.3, 359.6]) was associated with the experience of emotional abuse with physical and/or sexual abuse. Suicidality was also strongly associated with having experienced emotional abuse alone (OR 79.5, 95% CI [16.7, 377.4]). This study showed that emotionally abused young women had a greater risk of suicidality than those experiencing no abuse and that the combined experience of emotional with physical and/or sexual abuse was strongly associated with poor mental health outcomes.     

冠心病猝死心肌肌动蛋白缺失的免疫组织化学定量研究

应用免疫组织化学LSAB法和图像处理系统，对德国慕尼黑大学法医学研究所1994年尸检冠心病猝死和对照组病例（各15例）的心肌肌动蛋白缺失情况进行定量研究。发现冠心病猝死病例心肌纤维内有明显的肌动蛋白缺失，是大小不一，多发、散在分布；对照组无或仅局限性小灶状缺失。将检测结果定量分析比较，其差异非常显著，说明重度冠状动脉粥样硬化患者是否冠心病猝死，其心肌肌动蛋白缺失的范围和程度有明显差异，冠心病猝死和对照组病例心肌肌动蛋白缺失的差异具有诊断意义，而形态定量分析能较客观准确地反映心肌纤维内肌动蛋白缺失量的变化。     

Unwanted sex among young adults in the United States: the role of physical disability and cognitive performance

This study examined associations between unwanted sexual experiences and both physical disability and cognitive performance in a nationally representative sample of young adults. We used data from 11,878 participants (ages 26-32) in Waves I, III, and IV of the National Longitudinal Study of Adolescent Health (Add Health). Logistic regressions determined associations between physical disability and level of cognitive performance (using a modified Peabody Picture Vocabulary Test) and the odds of experiencing physically forced and nonphysically coerced sex. Approximately 24% of females and 4% of males reported unwanted sexual experiences. Compared to respondents without disabilities, females with a physical disability had greater odds of experiencing forced sex (OR = 1.49; 95% CI [1.06, 2.08]), whereas males with a physical disability had greater odds of coerced sex (OR = 1.90; 95% CI [1.02, 3.52]). Compared to those with average cognitive performance scores, females with scores above 110 had slightly higher odds of coerced sex (OR = 1.20; 95% CI [1.03-1.41]). Further research on pathways underlying these associations is needed to inform prevention efforts.     

冠心病心肌线粒体DNA5.0kb缺失的检测

目的探讨冠心病心肌线粒体DNA5.0kb缺失的检测。方法120例心脏的左、右心室肌各1份,分为正常对照组、病例相关组和病例组,每组40例80个样本。用断裂点连接PCR分别扩增样本含线粒体DNA5.0kb缺失的片段,巢式PCR检测含5.0kb缺失片段的扩增产物的准确性,半定量PCR对该产物进行定量,聚丙稀酰胺凝胶电泳检测PCR产物。结果在对照片段扩增成功的样本中,正常对照组未检出线粒体DNA5.0kb缺失;病例相关组检出2例,占6.07%(2/33);病例组检出29例,占85.29%(29/34);左、右心室肌线粒体DNA5.0kb缺失量分别为0.0015%~0.7813%和0.0008%~0.3906%。病例组与其他两组缺失率经χ2检验,其差异具有极显著性意义(P<0.001);左、右心室肌的缺失量经t检验,其差异具有极显著性意义(P<0.001)。结论冠心病心肌多有线粒体DNA5.0kb缺失,缺血明显的区域其缺失量也较高。     

冠心病猝死者心肌中SOCS-1和Bax的表达

目的采用免疫组化方法,观察细胞因子信号转导抑制因子-1(SOCS-1)和Bax在冠心病猝死(SCD)者心肌中的表达情况,探讨其对SCD诊断的意义。方法 25例诊断为SCD者心脏样本为实验组,25例非心血管疾病猝死者心脏样本为对照组。应用免疫组织化学方法检测SOCS-1和Bax在心肌中的表达,应用SPSS 17.0软件进行统计处理,组间比较采用秩和检验。结果 SCD猝死者心肌SOCS-1与Bax的表达明显高于对照组,Uc值SOCS-1为5.830 6,Bax为5.573,两种指标组间比较,差异均有显著性意义(P<0.01);SCD组中SOCS-1表达阳性以上且Bax表达弱阳性以上有22例,而正常对照组仅有1例。结论 SOCS-1与Bax均可能参与了细胞凋亡的过程,检测两种指标在心肌中阳性表达,可以为SCD的诊断提供客观依据,且联合检测可提高SCD诊断的特异性。     

人体冠心病心肌组织cTnI免疫组织化学研究

目的 研究cTnI免疫组织化学法诊断人体急性心肌梗死的法医病理学意义.方法 应用免疫组织化学法检测人体冠心病心肌组织cTnI的变化,进行图像分析,与HE染色法进行比较.结果 人体冠心病心肌组织急性心肌梗死区域心肌细胞内cTnI免疫组化染色缺染、分布失规律性;梗死修复区域纤维间质cTnI免疫组化染色弱阳性:陈旧性心肌梗死瘢痕区域纤维间质cTnI免疫组化染色阴性.失血性休克组近心内膜心肌细胞内cTnI免疫组化染色轻度增强,并见点灶状心肌细胞内cTnI免疫组化染色缺染.结论 cTnI免疫组织化学检测可以应用于人体急性心肌梗死的诊断.     

病毒性心肌炎和扩张性心肌病中Dystrophin蛋白的表达

目的探讨病毒性心肌炎和扩张性心肌病的发病机制及相互关系,从而提高心性猝死法医学鉴定的可靠性和准确性。方法对17例对照(包括正常心脏、冠心病、高血压性心脏病等),25例病毒性心肌炎和28例扩张性心肌病的心肌组织进行改良的病理学dystrophin免疫组织化学研究。结果dystrophin蛋白在对照组,病毒性心肌炎组和扩张性心肌病组中阳性表达率分别为100%,88%,57%,三组表达差异有显著性(P<0.05),且在病毒性心肌炎和扩张性心肌病组间表达有显著差异(P<0.05),经Spearman等级相关分析呈显著负相关(r=-0.526)。结论病毒性心肌炎和扩张性心肌病心肌中细胞骨架蛋白均有破坏,且随着由病毒性心肌炎进展为扩张性心肌病,dystrophin蛋白表达逐渐降低,说明在病毒性心肌炎和扩张性心肌病的发病机制中可能与dystrophin的被破坏有关,病毒感染并破坏心肌细胞骨架蛋白并最终导致心肌细胞坏死,心功能受损,从而使病毒性心肌炎进展为扩张性心肌病。     

青壮年猝死综合征心传导系统及心肌HHF35免疫组化研究

为了探讨青壮年猝死综合征（SMDS）的死亡原因与心性猝死之间的关系，作者对SMDS、冠心病、非心血管疾病死亡（正常对照）三组共23例心脏标本进行H．E和HHF35免疫组化观察．结果：9例SMDS中，8例心传导系统及心肌细胞出现小灶性HHF35阴性缺染区，而H．E染色未发现明显梗死灶；冠心病组7例均出现不同程度的心肌细胞缺染，呈广泛大面积分布；对照组心肌细胞、心传导系统及血管壁里均匀一致的阳性染色．表明部分SMDS死前已有早期心肌缺血或梗死等病变，其死亡原因应为急性心功能不全而致猝死．     

Immunostaining by complement C9: a tool for early diagnosis of myocardial infarction and application in forensic medicine

Before the first 12 hours, diagnosis of early myocardial infarctions is always difficult for forensic pathologists. We tested complement C9 expression in 121 formalin-fixed and paraffin-embedded heart samples by an immunohistochemical procedure. The heart specimens were separated into four groups: 33 cases in group 1 with typical ischemic damages histologically located, 20 cases in group 2 with death related to myocardial infarction on the basis of ischemic presentation on electrocardiogram but no obvious histological ischemic damage, 35 cases in group 3 with severe coronary disease without cause of death found at the autopsy, and 33 cases in group 4 without sign of myocardial infarction and without coronary disease. In the first group, all 33 heart samples showed a well-defined C9 expression in the necrotic areas. The second group in 17 of 20 cases showed positive areas for C9 expression. In the other three heart specimens, only few stained cells were observed whereas the painful symptoms had begun less than 1 h before death. The third group showed C9 immunopositive areas in six of 35 cases, few stained cells in 8 cases, and no C9 deposition in the 21 other cases. The last group showed no staining area. To avoid nonspecific C9 staining due to tissue autolysis, we studied C9 expression during a controlled putrefactive process in four cases included in group 1; staining was found only in infarcted myocardial areas, and was observed up to ten days. Specificity of C9 expression was evaluated to be 100% [89.4 to 100%] and sensitivity to be 85% [62.11 to 96.79%]. In conclusion, evaluation of immunohistochemical expression of C9 appears to be a highly sensitive and specific marker of early myocardial infarction, useful in forensic medicine if survival is more than 1 h after the beginning of myocyte damage.     

青壮年猝死综合征心肌细胞内Cx43的表达

目的观察连接蛋白43（Cx43）在青壮年猝死综合征（SMDS）者心肌细胞的表达,并探讨其法医学意义。方法筛选法医尸检案例45例,其中SMDS组、冠心病猝死组及对照组各15例。采用免疫组织化学和图像分析技术对不同组别Cx43蛋白在心肌细胞内的表达进行阳性单位（PU）定量检测,分析Cx43蛋白在各组表达的差异。所得数据进行统计学分析。结果 SMDS组心肌Cx43染色明显减弱,阳性着色条带分布不均、深浅不一,有的呈散在颗粒状;冠心病猝死组亦见类似变化;对照组未见明显变化。经统计分析发现,3组心肌细胞内Cx43表达的PU值存在显著性差异（P〈0.05）。结论 SMDS死前存在心肌缺血及心电紊乱,应属心性猝死范畴。     

Cathepsin-L在缺血心肌中的表达

目的检测cathepsin-L(CTSL)在大鼠早期缺血心肌中的表达变化,并探讨其法医学意义。方法建立大鼠早期心肌缺血模型,设置早期缺血组(early ischemic myocardium,EIM)、非缺血组(non-ischemic myocardium,NIM)、假手术组以及空白对照组,采用real-time PCR方法检测大鼠缺血后15min,30min,1h和2h CTSL mRNA的表达量,并进行组内和组间比较。收集心源性猝死者缺血心肌和机械性损伤致死者正常心肌样本,采用免疫组化染色方法观察心肌组织中CTSL蛋白表达。结果 EIM组CTSL mRNA表达量与NIM组、假手术组及空白组相比,在15min时无统计学意义(P>0.05),在30min、1h和2h时分别升高1.4、3.1和4.5倍(P<0.05);其余3组间差异无统计学意义(P>0.05)。观察10例冠脉狭窄程度Ⅲ～Ⅳ级的心源性猝死(SCD)者缺血心肌,CTSL表达增强。结论大鼠心肌缺血后早期即可检测到CTSL mRNA的升高,并在SCD冠脉狭窄死者缺血心肌中高表达,提示CTSL可作为心肌缺血与SCD的参考指标。     

Cardic death and apoptosis of myocardium

TdT-mediated Dutp nick end labeling (TUNEL) method was applied to detect apoptosis of myocardium of corpses dying from cardiac death. For arteriosclerotic coronary heart death, diffused apoptosis was observed around the border zones of histologically infarcted myocardium, and in the epithelial and smooth muscle of arteries. Few apoptosis cells were present for hypertensive heart death, and none for corpses dying from falling and hanging. Myocardium apoptosis may provide a new target for heart failure.     

皮肤切创愈合中caspase-3表达的免疫组化研究

目的探讨皮肤切创损伤愈合过程中,caspase-3在损伤区内的表达以及不同损伤时间caspase-3的变化规律。方法应用免疫组织化学技术对33例不同损伤时间小鼠皮肤切创组织中caspase-3的表达进行研究。同时以3例非切创小鼠皮肤组织做对照。结果伤后6h的损伤皮肤组织中可见少量中性粒细胞表达caspase-3,伤后12～24h,大部分浸润的中性粒细胞及部分单核细胞为caspase-3阳性。随伤后时间延长,caspase-3阳性细胞以单核细胞及成纤维细胞为主。伤后0～3h,caspase-3阳性细胞比率较低,为(4.53±6.53)%,12h后逐渐增加,伤后3d达高峰,为(62.66±4.84)%,其后逐渐下降。结论小鼠皮肤损伤愈合过程中,caspase-3可能在诱导损伤区内中性粒细胞、单核巨噬细胞及成纤维细胞发生凋亡过程中发挥重要作用,同时,caspase-3的规律性表达可用于损伤时间的推断。     

病毒性心肌炎肌动蛋白的免疫组化观察

对１０例尸检心脏标本进行了肌动蛋白（Ａｃｔｉｎ,Ａｔ）的免疫组化观察。依据Ｄａｌｓ标准的明确或界限性病毒性心肌炎５例,心肌组织内Ａｔ含量减损,呈局灶性或弥漫性淡染,偶见小灶性单个心肌细胞内Ａｔ缺失。心肌梗死２例,心肌组织内Ａｔ大片缺失;非心性死亡对照组３例,心肌组织内Ａｔ呈均匀一致的强阳性染色。结果表明,心肌组织内Ａｔ的免疫组化观察可望提高对不典型病毒性心肌炎诊断的敏感性,同时对区分轻度缺血性与炎症性心肌细胞损伤有参考价值     

VEGF在家兔缺血心肌中的表达及其死后稳定性研究

目的观察心肌中VEGF在死后一定时间的稳定性及表达的变化规律，评价其对死后诊断机体早期心肌缺血的作用。方法用冠状动脉结扎法建立家兔急性心肌缺血模型，应用SP法染色、图像分析和统计学处理系统，检测缺血心肌细胞内VEGF阳性表达面积和强度，并对VEGF在死后不同时间的稳定性进行比较。结果VEGF在缺血心肌组织中，见灶性或成片心肌细胞强阳性表达，部分细胞呈阴性或弱阳性表达，血管内皮及平滑肌细胞表达弱阳性，间质表达阴性；在4℃放置，随时间延长，缺血心肌组织VEGF阳性表达有减弱趋势，至10d时缺血心肌组织仍可见VEGF在少许心肌细胞胞浆内呈弱阳性表达。在4℃放置10d以内，缺血心肌和正常心肌标本之间VEGF阳性表达具有极显著性差异。结论VEGF能耐受一定程度自溶及腐败的影响，其免疫组化检测对于判断死后4℃放置10d以内的尸体是否出现过心肌缺血具有一定意义。