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目的鉴定在冠状动脉粥样硬化性心脏病猝死者心肌中心肌连接蛋白(connexin,CX)40、免疫及炎症相关的小分子RNA(micro155)的表达及探讨其法医病理学意义。方法在2014-2015年间法医尸体解剖工作中选出22例符合冠心病猝死的心脏标本(标本严格按照冠状动脉粥样硬化性心脏病的标准进行筛选)作为试验组,再选取10例非冠心病猝死者作为对照组;对筛选出两组中所有的蜡块进行连续切片,HE染色;利用免疫组织化学染色来检测CX40在心肌中的表达;蜡块心肌组织中提取micr RNA,利用RT-PCR法检测每组中mi R-155的表达情况;数据统计学处理采用SPSS18.0统计软件分析,P<0.05为差异有统计学意义。结果 HE染色观察分析:试验组切片镜下可见心肌纤维多处断裂,细胞间质充血水肿,且伴有脂肪变性和脂质沉积;有纤维斑块形成,内部有无定型的坏死崩解物质,镜下观察呈现针形空隙,底部和边缘有肉芽组织和纤维组织,并有泡沫细胞聚集和淋巴细胞浸润;对照组心肌细胞形态正常,各动脉管腔无狭窄;CX40免疫组织化学染色结果:非冠心病猝死组显示磷酸化心肌连接蛋白40大量分布于心肌闰盘处,排列整齐并有一定的规律性;冠心病猝死组显示心肌连接蛋白40在心肌梗死部位数量减少甚至完全消失,排列散乱,分布不均匀;RT-PCR结果表明mi R-155在冠心病猝死者中的表达显著上调,且在试验组和对照组中差异有统计学意义(P<0.01)。结论在冠心病猝死患者的心肌中CX40含量减少,mi R-155显著表达,为冠心病猝死法医学鉴定提供了理论依据。
Objective To identify the expression of connexin (CX) 40 in myocardium and immune and inflammation-associated micro-RNA in patients with sudden death of coronary heart disease and to explore its forensic pathological significance. Methods Twenty-two cases of sudden death from coronary heart disease (specimens were screened strictly according to the criteria of coronary heart disease) were selected as the experimental group during the autopsy of forensic autopsy from 2014 to 2015. Ten non-coronary heart disease Sudden death were used as control group. All the paraffin blocks of the two groups were screened and HE stained. The expression of CX40 in myocardium was detected by immunohistochemical staining. Method to detect the expression of mi R-155 in each group; statistical analysis of data using SPSS18.0 statistical software analysis, P <0.05 for the difference was statistically significant. Results The results of HE staining showed that there were many myocardial fibrosis, interstitial congestion and edema in the test group, accompanied by steatosis and lipid deposition, fibrous plaque formation, and the presence or absence of necrotic disintegration material inside, Microscopic observation showed acicular voids, granulation tissue and fibrous tissue at the bottom and margins, and foam cell aggregation and lymphocyte infiltration. The control group had normal myocardial cells with no stenosis of the arterial lumen. The results of CX40 immunohistochemical staining Sudden death in CHD group showed that the phosphorylated myocardial connexin 40 distributed in myocardial intercalated plate in a large number and arranged regularly with a certain regularity. The sudden death group of CHD showed that the number of myocardial connexin 40 decreased or even disappeared completely in myocardial infarction, The results of RT-PCR showed that the expression of mi R-155 in patients with sudden death of coronary heart disease was significantly up-regulated, and there was a significant difference between the experimental group and the control group (P <0.01). Conclusions The CX40 content and the expression of mi R-155 in the myocardium of patients with sudden death of coronary heart disease were significantly decreased, which provided a theoretical basis for forensic identification of sudden death of coronary heart disease.