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目的探讨类胰蛋白酶(tryptase)和类糜蛋白酶(chymase)在过敏反应死亡中表达及其与过敏反应死亡和冠心病猝死的关系,为过敏反应死亡的病理诊断和法医学鉴定提供新的形态学依据。方法从本教研室2008—2011年尸检档案中挑选病例70例,并搜集其原始档案资料、福尔马林固定包埋的心脏及肺脏蜡块,复阅HE切片。分为四组:A组:冠心病猝死(SCD,20例);B组:冠心病非猝死者(CHD,20例);C组:过敏性猝死(10例);D组:阴性对照(无明显动脉粥样硬化病变的死者,20例)。应用免疫组化染色(SP法)和图像定量分析法,观察每例肺脏、心脏的类胰蛋白酶和类糜蛋白酶染色情况和光密度。结果 SCD组、CHD组、过敏反应死亡组缺血心肌及肺脏内tryptase表达的OD值均高于阴性对照组,各组间比较均有显著差异(P<0.05)。肺脏内chymase表达的OD值在SCD组、CHD组和过敏反应死亡组均大于阴性对照组(P<0.05),SCD组、CHD组和过敏反应死亡组两两比较均无统计学意义(P>0.05)。结论类糜蛋白酶虽然在过敏反应死亡和冠心病猝死时表达有增强,但是表达量比较少,两者之间基本相同,该蛋白酶作为鉴别过敏反应死亡和冠心病猝死证据尚不充分。类胰蛋白酶在过敏反应死亡和冠心病猝死心和肺表达显著增强,可以作为过敏反应死亡和冠心病猝死医学鉴别的重要参考指标之一。
Objective To investigate the relationship between the expression of tryptase and chymase in the death of anaphylactic reaction and their association with the death of anaphylactic reaction and sudden death of coronary heart disease and to provide a new morphological basis for the pathological diagnosis and forensic identification of the death of anaphylactic reaction . Methods Seventy patients were selected from autopsy archives from 2008 to 2011 in our department and their original archives were collected. The heart and lung wax blocks were fixed in formalin, and the HE slices were reviewed. Group A: sudden death of coronary heart disease (SCD, 20 cases); Group B: non-sudden death of CHD (20 cases); Group C: sudden death of ankle (10 cases); Group D: negative control No obvious atherosclerosis in the deceased, 20 cases). Immunohistochemical staining (SP method) and image quantitative analysis were used to observe the staining and optical density of tryptase and chymase in each of the lungs and heart. Results The OD value of tryptase expression in ischemic myocardium and lung in the CHD group, CHD group and the death from anaphylaxis were significantly higher than those in the negative control group (P <0.05). The OD value of chymase expression in the lungs was higher in the SCD group, the CHD group and the death of the allergic reaction group than in the negative control group (P <0.05). There was no significant difference in the expression of chymase between the SCD group, the CHD group and the allergic reaction death group (P> 0.05). CONCLUSION Although the expression of chymase in the process of death from anaphylaxis and sudden death from coronary heart disease is enhanced, the expression of chymase is relatively low and the two are basically the same. The protease as evidence for identifying death from anaphylactic reaction and sudden death from coronary heart disease is not yet sufficient. Tryptase death in anaphylactic reactions and sudden cardiac death and coronary heart disease significantly increased cardiac and lung can be used as an important indicator of death from anaphylactic reactions and sudden cardiac death identified as an important reference.