摘要
目的探讨高血压脑出血(HICH)患者血肿周围组织超微结构变化与水通道蛋白-4 mRNA(AQP-4mRNA)表达的关系。方法选择山东玲珑英诚医院2018年6月至2020年6月行开颅手术治疗的HICH患者68例,术中取血肿周围组织观察超微结构变化、脑水肿病理变化,采用半定量RT-PCR法检测脑水肿组织AQP-4mRNA表达。另取正常脑组织标本30例作为对照组,采用半定量RT-PCR法检测AQP-4mRNA表达。68例HICH患者分别根据出血至手术时间和血肿量分组,比较各组AQP-4mRNA表达。结果脑组织超微结构变化:脑出血至手术时间5 h星形细胞胞体和周边足突肿胀对毛细血管造成压迫,粗面内质网扩张,内有大量水肿液,线粒体融合中的部分嵴和膜局部断裂;脑出血至手术时间36 h神经细胞部分变性,星形细胞明显肿胀,部分细胞变性、坏死;脑出血至手术时间86 h神经细胞变性,轴索内容物溶解,部分双层核膜融合或消失,管腔变窄甚至闭塞。脑组织病理变化:出血至手术时间5 h患者脑组织轻度水肿;出血至手术时间36 h患者脑组织中度水肿,可见部分肿胀细胞;出血至手术时间86 h脑组织重度水肿,细胞核消失,坏死。对照组、<6 h组、6~24 h组、25~72 h组、>72 h组AQP-4mRNA表达差异有统计学意义(F=5.072,P<0.05)。血肿量30~50 mL组、51~70 mL组、71~90 mL组、>90 mL组AQP-4mRNA表达差异无统计学意义(F=0.924,P>0.05)。结论HICH患者出血时间超微结构变化、病理改变、AQP-4mRNA表达有一致性,在72 h后病理显示水肿消退,AQP-4mRNA表达随之降低。
Objective To study the relationship between the ultrastructural changes of perihematoma tissue and the expression of aquaporin 4(AQP-4mRNA)in patients with hypertensive intracerebral hemorrhage(HICH).Methods A total of 68 patients with HICH underwent craniotomy in Shandong Linglong Yingcheng Hospital from June 2018 to June 2020 were selected.Tissue around the hematoma was taken during operation to observe the ultrastructural changes and pathological changes of cerebral edema.Semi-quantitative RT-PCR was used to detect the expression of AQP-4mRNA in brain edema tissue,with cerebral tissue from 30 normal brain specimens as control group.68 patients with HICH were grouped according to bleeding to operation time and hematoma volume,and the expression of AQP-4mRNA in each group was compared.Results Ultrastructural changes of brain tissue:5 hours(bleeding to operation time):The swelling of astrocyte cell bodies and surrounding foot processes caused pressure on capillaries,and the rough endoplasmic reticulum was expanded with plenty edema fluid inside.Cristae and membranes in mitochondrial fusion were partially broken.36 hours(bleeding to operation time):Nerve cells were partially degenerated,meanwhile astrocytes were obviously swollen,even degenerated and underwent necrotic.86 hours(bleeding to operation time):Nerve cells were degenerated,and axonal contents were dissolved.The double-layer nuclear membrane was partially fused or disappeared,with narrowing or even occlusion of the lumen.Pathological changes of brain tissue:5 hours(bleeding to operation time):Mild edema in brain tissue occurred in patients.36 hours(bleeding to operation time):Moderate edema in brain tissue with swollen cells were observed in patients.86 hours(bleeding to operation time):Severe brain edema occurred in patients,and cell nuclei were disappeared and underwent necrosis.AQP-4 mRNA expression were statistically significant different among the control group,the<6 h group,the 6-24 h group,the 25-72 h group,and the>72 h group(F=5.072,P<0.05).No significant difference in the expression of AQP-4 mRNA was detected in the hematoma volume 30-50 mL group,51-70 mL group,71-90 mL group,and>90 mL group(F=0.924,P>0.05).Conclusion At different bleeding times,changes of HICH patients in the ultrastructure,pathology and the expression of AQP-4mRNA in brain edema are consistent.After 72 hours,the pathology showed that the edema subsided and the expression of AQP-4mRNA decreased.
作者
姚成成
申洁心
姜书超
于鹏飞
董传强
Yao Chengcheng;Shen Jiexin;Jiang Shuchao;Yu Pengfei;Dong Chuanqiang(Department of Neurosurgery,Shandong Linglong Yingcheng Hospital,Yantai 265400,China;Clinical Lab,Shandong Linglong Yingcheng Hospital,Yantai 265400,China)
出处
《心脑血管病防治》
2023年第3期3-6,F0003,共5页
CARDIO-CEREBROVASCULAR DISEASE PREVENTION AND TREATMENT
基金
山东省科技发展计划项目(2018GSF119038)。
关键词
高血压脑出血
超微结构变化
脑水肿病理
水通道蛋白-4
Hypertensive intracerebral hemorrhage
Ultrastructural changes
Pathology of cerebral edema
Aquaporin-4
