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目的研究肥厚型心肌病(hypertrophic cardiomyopathy,HCM)死者心肌间质纤维组织含量及心肌细胞中骨桥蛋白的表达,探讨骨桥蛋白在鉴定HCM致死案件中的法医学意义。方法选取15例HCM致死者左心室心肌为HCM组、15例冠心病心肌肥厚致死者左心室心肌为冠心病组及20例交通事故及高坠致死者左心室心肌为对照组,应用HE染色、Masson三色染色法和免疫组化法比较3组左心室心肌间质中胶原容积分数及心肌细胞内骨桥蛋白阳性表达的变化,并利用图像分析软件进行统计学分析。结果 HCM组和冠心病组左心室心肌间质胶原容积分数高于对照组(P<0.05),而HCM组与冠心病组差异无统计学意义(P>0.05);HCM组和冠心病组左心室心肌细胞骨桥蛋白阳性表达积分光密度值均高于对照组(P<0.05),且HCM组高于冠心病组(P<0.05)。结论心肌间质胶原纤维含量的增高和骨桥蛋白过度表达可能在HCM心肌纤维化过程中发挥重要作用,可作为HCM致心源性猝死的辅助诊断指标。
Objective To study the myocardial interstitial fibrosis and the expression of osteopontin in cardiomyocytes of hypertrophic cardiomyopathy (HCM), and to explore the forensic significance of osteopontin in the identification of HCM-induced death. Methods Left ventricular myocardium of 15 HCM-induced death patients were selected as HCM group. Left ventricular myocardium of 15 CHD patients with CHD as coronary heart disease group and 20 left ventricular myocardium of traffic accident and high-lethal death as control group were selected. HE staining, Masson’s trichrome staining and immunohistochemistry were used to compare the changes of collagen volume fraction and intracellular osteopontin expression in left ventricular myocardium in the three groups. Statistical analysis was performed using image analysis software. Results The interstitial collagen volume fraction of left ventricular myocardium in HCM group and CHD group was higher than that in control group (P <0.05), but there was no significant difference between HCM group and CHD group (P> 0.05) The integral optical density of positive expression of osteopontin in ventricular myocardium was higher than that in control group (P <0.05), and HCM group was higher than that of coronary heart disease group (P <0.05). Conclusions The increase of myocardial interstitial collagen content and overexpression of osteopontin may play an important role in myocardial fibrosis of HCM and may be used as an auxiliary diagnostic indicator of sudden cardiac death caused by HCM.