CAJ | 학술논문

目的：探讨长期失神经支配环杓后肌形态学及半胱氨酸天冬氨酸蛋白酶－3（Caspase－3）表达水平的变化，为晚期喉神经修复选择时限提供参考。方法45例不同时间喉返神经损伤患者的环杓后肌标本按神经损伤时间分为3组：3～6个月（18例）、7～12个月（15例）、13～24个月（12例）；取行喉全切除术喉癌患者未受肿瘤侵犯侧的正常环杓后肌标本作为正常对照组（12例），各组标本均通过 H E染色观察肌肉形态，通过免疫组化染色、Western blot观察环杓后肌Caspase－3表达的变化趋势。结果随着失神经时间的延长，环杓后肌肌纤维细胞有不同程度的变性，肌细胞核内移、集中，呈串珠状排列。失神经各组Caspase－3在肌细胞核均有表达，3～6个月组表达量最高，其他各组逐渐下降，而对照组基本无表达。Western blot结果显示，对照组、失神经3～6个月、7～12个月、13～24个月组Caspase－3的相对表达量分别为1．30±0．03、20．78±0．11、11．33±0．43、3．14±0．17，失神经3～6个月组为对照组的21倍，7～12个月组为对照组的11倍，13～24个月组为对照组的3倍。结论失神经支配1年内是喉肌凋亡较严重时期，以后凋亡速度减慢，喉神经修复应尽量在1年内进行。
목적：탐토장기실신경지배배표후기형태학급반광안산천동안산단백매－3（Caspase－3）표체수평적변화，위만기후신경수복선택시한제공삼고。방법45례불동시간후반신경손상환자적배표후기표본안신경손상시간분위3조：3～6개월（18례）、7～12개월（15례）、13～24개월（12례）；취행후전절제술후암환자미수종류침범측적정상배표후기표본작위정상대조조（12례），각조표본균통과 H E염색관찰기육형태，통과면역조화염색、Western blot관찰배표후기Caspase－3표체적변화추세。결과수착실신경시간적연장，배표후기기섬유세포유불동정도적변성，기세포핵내이、집중，정천주상배렬。실신경각조Caspase－3재기세포핵균유표체，3～6개월조표체량최고，기타각조축점하강，이대조조기본무표체。Western blot결과현시，대조조、실신경3～6개월、7～12개월、13～24개월조Caspase－3적상대표체량분별위1．30±0．03、20．78±0．11、11．33±0．43、3．14±0．17，실신경3～6개월조위대조조적21배，7～12개월조위대조조적11배，13～24개월조위대조조적3배。결론실신경지배1년내시후기조망교엄중시기，이후조망속도감만，후신경수복응진량재1년내진행。
Objective To investigate the morphological alteration and the protein expression of caspase -3 in long -term denervated posterior cricoarytenoid muscles (PCAMs)in order to find the appropriate time point of rein‐neration in long -term denervated PCAMs .Methods A total of 45 patients with vocal paralysis were recruited and devided into 3 groups ,the 3~6 months denervation group ,the 6~12 months denervation group ,the 1~2 year denervation group .12 adults served as control group .The morphological alteration was evaluated using HE staining and the change in expression of caspase -3 ,an apoptosis related factor ,were observed using immunehistochemistry stain and western blot .Results With elongation of denervation time ,there were increased denaturation in the mus‐cle fibers .The nucleus moved inside and some of them concentrated .Caspase-3 showed weak staining in innerva‐ted ,however ,by 3-6 months of muscle denervation there was a significant accumulation of caspase -3 protein in myofibers ,6~12 months and 1~2 years of denervation ,expression of caspase -3 protein in myofibers was de‐creased significantly .In western blot ,the change in protein expression of caspase -3 was observed an 21-fold (P< 0 .01) increase from 3~6 months denervated muscles to innervated muscles ,11-fold (P< 0 .01) increase from 6~12 months denervated muscles to innervated muscles ,3~fold (P< 0 .01) increase from 1~2 year denervated muscles to innervated muscles .Conclusion The morphological alterations and changes in expression of caspase -3 indicated there was a high amplitude of apoptosis in denervated posterior cricoarytenoid muscles within 1 year .