不同组织化学染色在急性心肌缺血猝死鉴定中的应用研究  

Application research on different histochemical staining methods for identifying acute myocardial ischemia and sudden death

作　　者：陈冰[1] 陈阳[2] 闫宜峰[2] 陶香香[1] 何雷 

机构地区：[1]皖南医学院病理教研室,芜湖241001 [2]皖南医学院法医学系 [3]弋矶山医院病理科

出　　处：《山西医科大学学报》2013年第2期99-102,166,共5页Journal of Shanxi Medical University

基　　金：皖南医学院中青年科研基金资助项目(WK201214)

摘　　要：目的探讨不同组织化学染色方法在急性心肌缺血猝死心肌中的染色规律及其在法医学鉴定上的应用价值。方法采用HE染色、Nagar-Olsen染色(苏木精碱性复红苦味酸法)、Heidenhain染色(铁矾-苏木素-伊红染色)、Heidenhain氏苏木精法染色,对28例急性心肌梗死心肌和10例冠心病非心源性猝死心肌进行染色,并设10例正常心肌作为对照。结果 Nagar-Olsen染色、Heidenhain染色、Heidenhain氏苏木精法染色在急性心肌梗死心肌中阳性表达率分别为75%,54%,58%;在冠心病非心源性猝死心肌中阳性表达率分别为20%,10%和10%;在正常心肌组表达均呈阴性。上述三种方法在以上两组的阳性表达率比较未见差异(P>0.05)。但急性心肌梗死心肌组与非心源性猝死组及对照组阳性表达率比较差异有统计学意义(P<0.01)。其中在急性心肌梗死组中Heidenhain氏苏木精染色强阳性例数较高(12/14),Nagar-Olsen染色在梗死区边缘表现更显著。各组均行HE染色,显示在梗死区出现细胞核的改变,在非梗死区心肌纤维表现为细胞水肿,胞质红染,胞核无明显病变,与对照组心肌很难鉴别。结论 Nagar-Olsen染色、Heidenhain染色、Heidenhain氏苏木精染色在急性心肌缺血猝死诊断中均有应用价值,在实际工作中可以通过HE染色结合Heidenhain氏苏木精法染色以提高诊断率;通过HE染色结合Nagar-Olsen染色确定梗死区的范围。Objective To explore the value of different histological staining methods in the identification of acute myocardial ischemia and sudden death in the forensic medicine.Methods HE staining,Nagar-Olsen staining,Heidenhain staining,Heidenhain hematoxylin staining were used to observe the morphology of myocardium in 28 patients with acute myocardial infarction,10 coronary heart disease patients with non-cardiogenic sudden death and 10 normal controls.Results The positive rates were 75%,54% and 58% in AMI patients by Nagar-Olsen staining,Heidenhain staining,Heidenhain hematoxylin staining,respectively.The positive rates were 20%,10% and 10% in non-cardiogenic sudden death patients.The staining was negative in normal controls.The positive expression rate was not significantly different among three methods in two groups（P0.05）.The positive rates were significantly different among three groups（P0.01）.The strongly positive rate by Heidenhain hematoxylin staining was 86% in AMI patients（12/14）.The myocardial infarct was obvious in the edge by Nagar-Olsen staining.HE staining results in three groups displayed the distinct changes of nuclear in the infarct area,and edema,red cytoplasmic staining and no significant lesions of the nucleus in non-infarct myocardium.Conclusion Nagar-Olsen,Heidenhain and Heidenhain hematoxylin staining methods may be useful in the diagnosis of acute myocardial ischemia and sudden death.The combination of HE staining and Heidenhain hematoxylin staining could improve the diagnostic rate,and HE staining and Nagar-Olsen staining could identify the area of infarction.

关 键 词：急性心肌缺血 猝死 组织学染色 

分 类 号：DF795[医药卫生—法医学]