中国危重病急救医学
中國危重病急救醫學
중국위중병급구의학
CHINESE CRITICAL CARE MEDICINE
2008年
11期
674-677,插2
,共5页
郭富强%徐玉川%陈隆益%杨友松%董凌琳%代红源%黄雨兰%韦永胜%李晓佳%吴文斌%曾宪容%唐建%赵冬冬%YANG Zheng-lin%杨果
郭富彊%徐玉川%陳隆益%楊友鬆%董凌琳%代紅源%黃雨蘭%韋永勝%李曉佳%吳文斌%曾憲容%唐建%趙鼕鼕%YANG Zheng-lin%楊果
곽부강%서옥천%진륭익%양우송%동릉림%대홍원%황우란%위영성%리효가%오문빈%증헌용%당건%조동동%YANG Zheng-lin%양과
脑出血%脑水肿%水孔蛋白类%病理学%超微结构
腦齣血%腦水腫%水孔蛋白類%病理學%超微結構
뇌출혈%뇌수종%수공단백류%병이학%초미결구
intracerebral hemorrhage%brain edema%aquaporin%pathology%ultrastructure
目的 观察脑出血患者血肿周围组织水通道蛋白-4(AQP-4)mRNA表达,探讨其与脑水肿、病理及超微结构变化的关系.方法 对30例脑出血患者采取非功能区小窗漏斗式人颅,从入颅路径过程中必须切除的脑组织里靠近血肿旁1 cm脑组织作为观察组.把远离血肿的脑组织作为对照组(发病12 h以内,7例),按发病到手术时间将观察组分为＜6 h、6～12 h、12～24 h、24～72 h、＞72 h组.采用逆转录-聚合酶链反应(RT-PCR)检测血肿周围脑组织AQP-4 mRNA表达;光镜和电镜下观察脑水肿、血肿组织病理及超微结构的动态变化.结果 对照组脑组织未见明显AQP-4 mRNA表达,形态和结构基本正常.观察组＜6 h脑组织AQP-4 mRNA表达微弱(1.17±0.41),仅胶质细胞轻微水肿;6 h后AQP-4 mRNA表达逐渐明显,除胶质细胞水肿外,毛细血管内皮细胞和神经细胞开始水肿,紧密连接逐渐开放,12～72 h组AQP-4 mRNA表达至高峰(3.50±0.55,3.60±60.55,P均＜0.01),光镜下观察脑细胞水肿损伤最明显,电镜下观察神经细胞、胶质细胞和毛细血管内皮细胞变性明显;72 h后AQP-4 mRNA表达和损伤逐渐好转;5 d时损伤开始恢复,8 d时基本好转.相关分析显示,AQP-4 mRNA表达与脑水肿程度、血肿大小呈显著正相关(r==0.67,P＜0.01,r2=0.44,P＜0.05).结论 脑出血后血肿周围组织继发性水肿和损伤可能与AQP-4 mRNA的表达有关,及早清除血肿也许有助于降低AQP-4 mRNA的表达和减轻脑水肿损伤.
目的 觀察腦齣血患者血腫週圍組織水通道蛋白-4(AQP-4)mRNA錶達,探討其與腦水腫、病理及超微結構變化的關繫.方法 對30例腦齣血患者採取非功能區小窗漏鬥式人顱,從入顱路徑過程中必鬚切除的腦組織裏靠近血腫徬1 cm腦組織作為觀察組.把遠離血腫的腦組織作為對照組(髮病12 h以內,7例),按髮病到手術時間將觀察組分為＜6 h、6～12 h、12～24 h、24～72 h、＞72 h組.採用逆轉錄-聚閤酶鏈反應(RT-PCR)檢測血腫週圍腦組織AQP-4 mRNA錶達;光鏡和電鏡下觀察腦水腫、血腫組織病理及超微結構的動態變化.結果 對照組腦組織未見明顯AQP-4 mRNA錶達,形態和結構基本正常.觀察組＜6 h腦組織AQP-4 mRNA錶達微弱(1.17±0.41),僅膠質細胞輕微水腫;6 h後AQP-4 mRNA錶達逐漸明顯,除膠質細胞水腫外,毛細血管內皮細胞和神經細胞開始水腫,緊密連接逐漸開放,12～72 h組AQP-4 mRNA錶達至高峰(3.50±0.55,3.60±60.55,P均＜0.01),光鏡下觀察腦細胞水腫損傷最明顯,電鏡下觀察神經細胞、膠質細胞和毛細血管內皮細胞變性明顯;72 h後AQP-4 mRNA錶達和損傷逐漸好轉;5 d時損傷開始恢複,8 d時基本好轉.相關分析顯示,AQP-4 mRNA錶達與腦水腫程度、血腫大小呈顯著正相關(r==0.67,P＜0.01,r2=0.44,P＜0.05).結論 腦齣血後血腫週圍組織繼髮性水腫和損傷可能與AQP-4 mRNA的錶達有關,及早清除血腫也許有助于降低AQP-4 mRNA的錶達和減輕腦水腫損傷.
목적 관찰뇌출혈환자혈종주위조직수통도단백-4(AQP-4)mRNA표체,탐토기여뇌수종、병리급초미결구변화적관계.방법 대30례뇌출혈환자채취비공능구소창루두식인로,종입로로경과정중필수절제적뇌조직리고근혈종방1 cm뇌조직작위관찰조.파원리혈종적뇌조직작위대조조(발병12 h이내,7례),안발병도수술시간장관찰조분위＜6 h、6～12 h、12～24 h、24～72 h、＞72 h조.채용역전록-취합매련반응(RT-PCR)검측혈종주위뇌조직AQP-4 mRNA표체;광경화전경하관찰뇌수종、혈종조직병리급초미결구적동태변화.결과 대조조뇌조직미견명현AQP-4 mRNA표체,형태화결구기본정상.관찰조＜6 h뇌조직AQP-4 mRNA표체미약(1.17±0.41),부효질세포경미수종;6 h후AQP-4 mRNA표체축점명현,제효질세포수종외,모세혈관내피세포화신경세포개시수종,긴밀련접축점개방,12～72 h조AQP-4 mRNA표체지고봉(3.50±0.55,3.60±60.55,P균＜0.01),광경하관찰뇌세포수종손상최명현,전경하관찰신경세포、효질세포화모세혈관내피세포변성명현;72 h후AQP-4 mRNA표체화손상축점호전;5 d시손상개시회복,8 d시기본호전.상관분석현시,AQP-4 mRNA표체여뇌수종정도、혈종대소정현저정상관(r==0.67,P＜0.01,r2=0.44,P＜0.05).결론 뇌출혈후혈종주위조직계발성수종화손상가능여AQP-4 mRNA적표체유관,급조청제혈종야허유조우강저AQP-4 mRNA적표체화감경뇌수종손상.
Objective To observe the expression of aquaporin-4 (AQP-4) mRNA and study the relationship between AQP-4,brain edema,pathological changes and uhrastructure of perihematoma tissue in intracerebral hemorrhage (ICH) patients.Methods Intracranial operation was performed via nonfunctional area with a funnel-like approach on 30 ICH patients.The brain tissue which must be removed 1 cm away the hematoma was removed within 12 hours for observation as normal brain tissue and taken as the control group (7 patients),and which of the brain tissue within 1 cm around hematoma was taken as the study specimens.The experimental group was subdivided into five groups according to the time interval after ICH;＜6 hours (6 cases),6-12 hours (7 cases),12-24 hours (5 cases),24-72 hours (6 cases),and＞72 hours (6 cases).Expression of the AQP-4 mRNA,brain edema,pathological and ultrastructural changes were observed with reverse transcription-polymerase chain reaction (RT-PCR),light microscope and electron microscope. Results The expression of the AQP-4 mRNA was not remarkable,the morphology and construction were basically normal in control group.The expression of AQP-4 mRNA was mild (1.17±0.41 ) and there was edema of neuroglia in the ＜6 hours group.After 6 hours,besides neuroglial edema,the expression of the AQP-4 mRNA was gradually obvious,capillary endothelial cells began to swell too,and tight junctions gradually began to loosen.In the 12 - 72 hours group the expression of the AQP-4 mRNA reached its peak (3.50 ± 0.55,3.60±0.55,both P＜ 0.01 ),and brain edema was most prominent,and electron microscopy showed that neurons,neuroglia,and capillary endothelial cells were markedly deformed.After 72 hours,the expression of AQP-4 mRNA gradually recovered,and brain cells showed less damage.On the 5th day the damage began to repair,and on the 8th day,the damage was basically repaired.The correlation analysis showed that there was a remarkable positive correlation between the expression of the AQP-4 mRNA and the degree of brain edema and the size of hematoma (r1=0.67,P＜0.01;r2=0.44,P＜0.05). Conclusion Secondary edema and brain damage may correlate with the expression of the AQP-4 mRNA in the perihematoma brain edema area. Removal of hematoma will help decrease the AQP-4 mRNA expression and brain edema damage in the early stage.
