脑出血患者血肿周围组织性反应与细胞凋亡的相关性研究.docVIP

脑出血患者血肿周围组织炎性反应与细胞凋亡的相关性研究 2007-12-09 22:27 【摘要】 目的 探讨脑出血患者血肿周围组织炎性反应与细胞凋亡的关系。方法 对30例手术的脑出血患者于血肿旁约1 cm处取少许脑组织作为试验组，按发病到手术的时间将试验组分为6 h(6例)、6~12 h(7例)、12~24 h(5例)、24~72 h(6例)、72 h(6例)。从前两组中选7例患者于手术入颅路径上远隔血肿处取少许脑组织作为对照组。应用苏木素-伊红(HE)染色、免疫组化染色、末端脱氧核苷酸转移酶介导的dUTP缺口末端标记法（TUNEL）、逆转录-聚合酶链反应（RT-PCR）分别观察组织病理、炎性细胞浸润和小胶质细胞增生、凋亡细胞、促凋亡基因(Bax)、抗凋亡基因(Bcl-x)的变化情况。 结果 光镜观察显示:对照组和试验组6 h内脑组织基本正常，试验组6~12 h损伤较轻，12~24 h损伤较重，24~48 h损伤严重，以后逐渐好转，8 d时与对照组相似。免疫组化显示:中性粒细胞、淋巴细胞、巨噬细胞浸润从6~12 h逐渐明显，12~24 h达高峰(P均0.01)，小胶质细胞增生从24~72 h开始，72 h以后明显增强(P均0.01)；凋亡细胞、Bax蛋白表达从6~12 h开始增加，12~24 h达高峰(P0.05或P0.01)，Bcl-x蛋白及其mRNA表达从12~72 h有增加的趋势，但差异无显著性。RT-PCR显示:Bax mRNA表达与免疫组化结果相似;相关分析显示:中性粒细胞、淋巴细胞、巨噬细胞浸润和小胶质细胞增生与凋亡细胞、Bax蛋白和Bax mRNA表达呈显著正相关(P0.05或P0.01)，与Bcl-x蛋白及其mRNA表达无相关性(P均0.05)。结论 脑出血后血肿周围组织的炎性反应与细胞凋亡关系密切，并与组织病理损伤相一致。??? 【关键词】 脑出血； 血肿周围组织； 炎性反应； 细胞凋亡 Study of relationship between inflammatory response and apoptosis in perihematoma region in patients with intracerebral hemorrhage GUO Fu-qiang, LI Xiao-jia, CHEN Long-yi, YANG Hong, DAI Hong-yuan, WEI Yong-sheng, HUANG Yu-lan,YANG You-song, SUN Hong-bin, XU Yu-chuan, YANG Zheng-lin. Department of Neurology, Sichuan Provincial People′s Hospital, Chengdu 610072, Sichuan, China???????OBJECTIVE: To investigate the relationship between inflammatory response and cell apoptosis in the perihematoma region in patients with intracerebral hemorrhage (ICH). METHODS: Surgical specimens were obtained from the area 1 cm adjacent to the hematoma. Thirty patients with ICH were divided into five groups: 6, 7, 5, 6, 6 patients in surgery＜6 hours, 6-12 hours, 12-24 hours, 24-72 hours and 72 hours groups after the onset, respectively. The control group specimens were obtained from the brain tissues distant to the hematoma in the process of craniotomy in the patients of two former groups. Sections were stained with hematoxylin and eosin (HE) for the examination of pathological changes. Immunohistochemistry, terminal deoxynucleotidyl transferase mediated dUTP biotin nick end labelin