本文選題：法醫(yī)病理學(xué)　切入點：冠心病　出處：《山西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:研究冠心病猝死者心肌中腦利鈉肽前體(proBNP)及心血中氨基末端腦利鈉肽前體(NTproBNP)和可溶性ST2(sST2)的表達變化,探討proBNP、NTproBNP、sST2在法醫(yī)學(xué)實踐中診斷冠心病猝死及心肌缺血嚴重程度的應(yīng)用價值。方法:選取山西醫(yī)科大學(xué)司法鑒定中心2011-2016年尸檢案例標本共60例,分為冠心病猝死組、單純冠脈狹窄組及正常對照組,每組各20例。每個案例取左心室前壁及左心室后壁各一塊及右心血樣本10ml。運用免疫組織化學(xué)染色、Western印跡法檢測心肌樣本中proBNP的表達;采用RT-qPCR技術(shù)檢測心肌中BNPmRNA的表達;采用ELISA法檢測血漿中NTproBNP和sST2的含量。結(jié)果:(1)冠心病猝死組、單純冠脈狹窄組心肌組織中proBNP免疫組化染色均為陽性染色,正常對照組未見明顯陽性染色。(2)冠心病猝死組、單純冠脈狹窄組心肌組織proBNP蛋白相對表達量高于正常對照組,差異具有統(tǒng)計學(xué)意義(P0.05)。(3)冠心病猝死組、單純冠脈狹窄組心肌組織內(nèi)BNPmRNA相對表達量較正常對照組明顯升高,差異具有統(tǒng)計學(xué)意義(P0.05)。(4)冠心病猝死組、單純冠脈狹窄組血漿內(nèi)NTproBNP的含量較正常對照組明顯升高;冠心病猝死組、單純冠脈狹窄組及正常對照組NTproBNP數(shù)據(jù)兩兩比較,表達差異均具有統(tǒng)計學(xué)意義(P0.05)。(5)冠心病猝死組、單純冠脈狹窄組血漿內(nèi)sST2的含量較正常對照組明顯升高,冠心病猝死組、單純冠脈狹窄組及正常對照組sST2數(shù)據(jù)兩兩比較,其差異均具有統(tǒng)計學(xué)意義(P0.05)。結(jié)論:(1)心肌缺血時心肌組織proBNP表達升高,proBNP可作為判斷心肌缺血及冠心病猝死輔助指標。(2)測定血漿中NTproBNP和sST2有助于鑒別冠心病的嚴重程度及是否為冠心病猝死;聯(lián)合檢測proBNP、NTproBNP、sST2對冠心病猝死的診斷更具優(yōu)勢。
[Abstract]:Objective: to study the expression of brain natriuretic peptide precursor proBNPs in myocardium and the expression of N-terminal brain natriuretic peptide precursor NTproBNPand soluble ST2P ST2 in cardiac blood of patients with sudden coronary heart death.To explore the application value of proBNPN NTproBNPsST2 in the diagnosis of sudden death of coronary heart disease and severity of myocardial ischemia in forensic practice.Methods: a total of 60 autopsy specimens were selected from Shanxi Medical University Forensic Identification Center from 2011 to 2016. They were divided into three groups: sudden coronary death group, coronary artery stenosis group and normal control group, with 20 cases in each group.A sample of 10 ml of left ventricular anterior wall and left ventricular posterior wall and 10 ml of right ventricular blood were taken from each case.Immunohistochemical staining was used to detect the expression of proBNP in myocardial samples, RT-qPCR technique was used to detect the expression of BNPmRNA in myocardium, and ELISA was used to detect the contents of NTproBNP and sST2 in plasma.Results proBNP immunohistochemical staining was positive in coronary heart disease sudden death group and simple coronary artery stenosis group, but no obvious positive staining was found in normal control group.The relative expression of proBNP protein in myocardial tissue of coronary artery stenosis group was higher than that of normal control group, and the difference was statistically significant (P 0.05. 01. 3) the relative expression of BNPmRNA in myocardial tissue of coronary artery stenosis group was significantly higher than that of normal control group, and that of coronary artery stenosis group was significantly higher than that of normal control group.The difference was statistically significant (P < 0.05). The plasma NTproBNP level in the coronary artery stenosis group was significantly higher than that in the normal control group, and the NTproBNP data of the coronary artery death group, the simple coronary artery stenosis group and the normal control group were significantly higher than those of the normal control group.The expression of sST2 was significantly higher in patients with coronary artery stenosis than that in control group. The sST2 data of sudden coronary death group, simple coronary artery stenosis group and normal control group were compared with each other.The differences were statistically significant (P 0.05).Conclusion the increased expression of proBNP in myocardial tissue during myocardial ischemia can be used as an auxiliary index to judge myocardial ischemia and sudden death of coronary heart disease. The determination of NTproBNP and sST2 in plasma is helpful to distinguish the severity of coronary heart disease and whether it is sudden death of coronary heart disease.Combined detection of proBNPN NTproBNPs ST2 is more advantageous in the diagnosis of sudden coronary death.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：D919

【參考文獻】

相關(guān)期刊論文 前10條

1 耿家峰;;N端腦鈉肽前體、脂蛋白(a)與冠心病患者冠狀動脈病變的相關(guān)性[J];實用臨床醫(yī)藥雜志;2016年15期

2 史潔茹;田成俊;曾強;郭相杰;路健;高彩榮;;過敏性和冠心病猝死者心肌組織中肥大細胞類胰蛋白酶、腦利鈉肽的表達[J];法醫(yī)學(xué)雜志;2016年03期

3 鄭勛;宋京郁;;皮試與冠狀動脈性猝死相關(guān)尸檢2例[J];延邊大學(xué)醫(yī)學(xué)學(xué)報;2015年04期

4 張美玲;;急性心肌梗死患者肌鈣蛋白與冠狀動脈狹窄程度的關(guān)系[J];當代醫(yī)學(xué);2015年33期

5 李鳳;李玉軍;王凱;李宏;冉雯雯;楊平;;大鼠應(yīng)激性心肌病模型心肌組織BNP的表達變化[J];中國法醫(yī)學(xué)雜志;2015年05期

6 劉奇;王杰;于燕妮;黃映康;夏冰;樓迪棟;;300例心源性猝死案例的法醫(yī)學(xué)鑒定分析[J];中國法醫(yī)學(xué)雜志;2015年03期

7 何金山;;心臟性猝死的進展[J];臨床心電學(xué)雜志;2015年03期

8 李艷芳;;血清心肌肌鈣蛋白Ⅰ、肌紅蛋白和肌酸激酶同工酶檢測在冠心病早期診斷中的價值[J];中國實驗診斷學(xué);2014年05期

9 陳皓倫;白延平;王晨霞;;心源性猝死的危險因素及流行病學(xué)研究進展[J];醫(yī)學(xué)綜述;2014年09期

10 耿旭;馬賓;;BNP及NT-proBNP和心肌缺血缺氧關(guān)系的研究進展[J];醫(yī)學(xué)綜述;2014年08期

相關(guān)碩士學(xué)位論文 前1條

1 孫續(xù)祿;SCD心臟ANP與BNP的免疫組織化學(xué)研究[D];重慶醫(yī)科大學(xué);2005年

，

本文編號：1722074