脑出血患者血肿周围组织水通道蛋白-4表达与脑水肿及病理超微结构变化的关系  

The relationship between the aquaporin-4 and brain edema, pathologic change, ultrastructure in perihematoma tissue in patients with intracerebral hemorrhage

作　　者：郭富强[1] 徐玉川[2] 陈隆益[3] 杨友松[1] 董凌琳[1] 代红源[1] 黄雨兰[1] 韦永胜[1] 李晓佳[1] 吴文斌[1] 曾宪容[1] 唐建[3] 赵冬冬[3] YANG Zheng-lin 杨果[5] 

机构地区：[1]四川省人民医院神经内科,成都,610072 [2]四川省人民医院病理科,成都,610072 [3]四川省人民医院神经外科,成都,610072 [4]美国犹他大学分子生物学与遗传研究中心 [5]四川大学华西基础医学与法医院电镜室

出　　处：《中华危重病急救医学》2008年第11期-,共5页Chinese Critical Care Medicine

基　　金：四川省医药卫生科研基金

摘　　要：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.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

关 键 词：脑出血 脑水肿 水孔蛋白类 病理学 超微结构 

分 类 号：R686[医药卫生—骨科学]