海洛因海绵状白质脑病急性意识障碍的临床及病理改变  

Clinical manifestation and pathogenesis of acute consciousness disorders among heroin spongiform leukoencephalopathy

作　　者：陈强[1] 陆兵勋[1] 周亮[1] 尹恝[1] 宋景贵[1] 

机构地区：[1]南方医科大学南方医院神经内科,广州510515

出　　处：《中国急救医学》2007年第4期302-304,387,共4页Chinese Journal of Critical Care Medicine

基　　金：广东省自然科学基金项目(No.020051A)

摘　　要：目的探讨海洛因海绵状白质脑病(heroin spongiform leukoencephalopathy,HSLE)急性意识障碍的临床及病理改变并进行病因分析。方法对2000-03～2006-10入院的39例HSLE患者中伴急性意识障碍的9例进行临床、CT和MRI分析。死亡的其中4例病例进行脑局部解剖,检查HE染色、MBP免疫组化染色、caspase-3免疫组化染色以及TUNEL染色。利用显微镜观察分析脑不同部位细胞凋亡数及与caspase-3阳性细胞之间的关系。并选4例非脑部死亡病例作为对照。结果9例以意识障碍起病的HSLE患者中,死亡5例。9例影像学均表现为广泛的白质损害,并合并有脑干病灶。HE染色及MBP免疫组化染色显示脑白质广泛脱髓鞘改变。在深层白质TUNEL阳性细胞和caspase-3阳性细胞的表达明显高于浅层白质(t=43．64,P＜0．01;t=13．78,P＜0．01)和正常对照组。结论广泛的白质损害和脑干受累是HSLE急性意识障碍的主要原因,基础病因可能为HSLE少突胶质细胞凋亡导致白质空泡样变。Objective To investigate the clinical manifestation and pathogenesis and to analyse the cause of acute consciousness disorders among heroin spongiform leukoencephalopathy （ HSLE）. Methotis 9cases with acute disorders among 39 cases of HSLE, entered hospital from March 2000 to October 2006, were evaluated by the clinic data , CT and MRI. 4 cases of HSLE and 4 cases of sudden death as the control were autopsied locally and stained with HE, TUNEL method and immunohistochemistry of myelin basic protein （ MBP） and caspase - 3. The Quantification of positive cells was exam- ined by microscopy, and the number of apoptosis cells in different parts of HSLE was counted and its relationship with caspase - 3 was analyzed. Results 5 cases died among 9 acute consciousness disorders cases. The image of all 9 cases showed extensive white matter damage and brain stem lesions. HE and im- munohistochemistry of MBP staining showed extensively demyelination of white matter. TUNEL positive cells and caspase -3 protein were observed obviously in the deep white matter in HSLE, compared with the shallow white matter and the normal control （ t =43.64,P 〈0. 01and t = 13.78 ,P 〈0.01 ）. Conclusion Extensive spongiform damage of white matter and brain stem lesions were the main reasons of acute disorders among HSLE. White matter spongiform induced by oligodendrocytes apoptosis was observed in HSLE, which might be involved in the cause of HSLE.

关 键 词：海洛因海绵状白质脑病 意识障碍 影像 CASPASE-3 

分 类 号：R742.89[医药卫生—神经病学与精神病学]