Fn、HSP70在冠心病猝死心肌中表达诊断意义.docVIP

Fn、HSP70在冠心病猝死心肌中表达诊断意义 　 作者：孙忠国 张凡 成日青 张九鸿 【摘要】 目的： 探讨冠心病猝死心肌组织Fn、HSP70染色改变，为法医学鉴定冠心病猝死提供客观依据。方法： 选择35例冠心病猝死案例、30例冠心病死亡案例以及32例非冠心病死亡案例，用免疫组化方法对比检测纤维连接蛋白（Fibronectin Fn）和热休克蛋白70（heat shock protein70 HSP70）的表达。结果： 纤维连接蛋白在35例冠心病猝死案例、冠心病死亡案例以及非冠心病死亡案例中均有不同程度的阳性表达，且冠心病组的表达水平明显高于冠心病猝死组和非冠心病死亡组（Plt;0.05）；冠心病猝死组的表达水平明显高于非冠心病死亡组（Plt;0.05）；HSP70在冠心病猝死案例、冠心病死亡案例组呈阳性表达，冠心病组表达水平明显高于冠心病猝死组（Plt;0.05），非冠心病死亡组均呈阴性表达；Fn在冠心病猝死组中的表达与HSP70呈明显正相关（Plt;0.05）。结论： 纤维连接蛋白和HSP70的阳性表达是心肌缺血和损伤的灵敏指标，对推断冠心病猝死具有一定的实际应用价值。 【关键词】 冠心病猝死；纤维连接蛋白；热休克蛋白70；免疫组织化学 【ABSTRACT】 Objective: To investigate the change of Fn HSP70s expressions in sudden coronary death and search for reasonable basis for forensic pathology to diagnose sudden coronary death.Methods: The expressions of Fn、HSP70 proteins were detected by immmunohistochemistry method in thirtyfive cases died of sudden coronary death、thirty cases died of coronary heart disease and thirtytwo cases died of disease.Results: All cases have various level expression of Fn and the expression level of coronary heart disease is higher than that of sudden coronary death among nosudden coronary death（Plt;0.05）;the expression level of sudden coronary death is higher than that of nosudden coronary death（Plt;0.05）;HSP70 have positive expresssion only in sudden coronary death and coronary heart disease The expression of HSP70 in coronary heart disease is higher than that of sudden coronary death. There is positive correlation between the expression of HSP70 and Fn in sudden coronary death.Conclusion: Fn and HSP70 are sensitive index to myocardiums injury and anemic so they have practical value for forensic pathology to diagnose sudden heart death. 【KEY WORDS】 Sudden Coronary Death; Fn; HSP70; Immunohistochemistry 猝死者往往预先没有任何征兆或症状和体征极轻微，死亡意外而且突然，无有医生在场，因此易引起怀疑，而冠心病是猝死的常见原因，常规病理学方法观察缺乏典型的形态学依据，给冠心病猝死的诊断增加了难度，目前基层法医工作者对冠心病猝死的鉴定主要还是依赖于排除法，即在排除暴力、中毒及其他疾病致死的基础上，结合冠状动脉明显的粥样硬化斑块病变作出冠心病猝死的鉴定。纤维连接蛋白和HSP70是两个对组织损伤较为敏感的指标，在急慢性炎症过程中都存在阳性表达，而且冠心病猝死心肌的病理变化肯定与长期存在明显症状的冠心病死亡