脑淀粉样血管病所致脑出血的免疫性血管病理损害初步研究  

Preliminary Study of Immunological Vascular Damage of Cerebral Amyloid Angiopathy Related Hemorrhage

作　　者：顾小花[1] 徐俊 程欣欣[3] 张巧全[4] 时建铨[5] 

机构地区：[1]江苏省苏北人民医院重症医学科,扬州225001 [2]苏北人民医院脑科中心神经内科,神经医学研究所 [3]南京医科大学附属脑科医院康复科 [4]南京医科大学附属脑科医院病理科 [5]南京市第一医院神经内科

出　　处：《中国卒中杂志》2016年第8期631-635,共5页Chinese Journal of Stroke

基　　金：国家自然科学基金资助项目(81471215,81271211);江苏省社会发展重点项目(BE2015665);江苏省自然科学基金(BK20151592)

摘　　要：目的回顾性分析外科手术治疗的自发性脑出血(intracerebral hemorrhage,ICH)病理标本中脑淀粉样血管病(cerebral amyloid angiopathy,CAA)及相关免疫-血管因子共表达情况,探讨CAA-ICH的免疫性血管病理损害可能机制。方法收集2010-2011年46例ICH患者的手术病理标本,其中男27例,女19例,平均年龄(56±15)岁。免疫组化荧光检测β-淀粉样蛋白(amyloidβ,Aβ)与晚期糖基化终产物受体(glycosylation end products,RAGE)、低密度脂蛋白受体相关蛋白1(low-density lipoprotein receptor related protein-1,LRP1)蛋白的共表达情况。结果 46例ICH患者中8例(男5例,女3例)确诊为CAA,占17.39%,确诊为CAA的8例患者脑组织标本均有Aβ、RAGE、LRP1蛋白的共表达(阳性率100%),而在非CAA自发性脑出血患者中均无共表达。CAA-ICH组的LRP1表达水平较非CAA-ICH组显著降低(P=0.031),而CAA-ICH组的RAGE表达水平较非CAA-ICH组显著升高(P=0.015)。结论 CAA是ICH的重要病因之一,CAA相关的免疫-血管因子RAGE、LRP1蛋白异常表达,在ICH发病机制中可能有重要作用。Objective To retrospectively analyze the prevalence of cerebral amyloid angiopathy（CAA） in the patients with spontaneous intracerebral hemorrhage（ICH） who received surgical treatment,and related the immune vascular factor co-expressions as to explore the possible immunological vascular damage of CAA-ICH.Methods Surgical samples of 46 ICH patients from 2010 to 2011 were enrolled, including 27 male patients and 19 female patients. The average age was 56±15 years old. The co-expression of amyloid β（Aβ）, glycosylation end products（RAGE） and low-density lipoprotein receptor related protein-1（LRP1） protein in the samples was detected by immunofluorescence and immunohistochemistry.Results Among 46 cases of ICH patients, 8 patients（17.39%, 5 males and 3 females） were diagnosed with CAA by pathology. The co-expression（positive rate 100%） of Aβ, LRP1 and RAGE proteins were detected in the patients with CAA, while others patients did not show co expression of Aβ,LRP1 and RAGE proteins. Compared with that in others patients, the level of LRP1 expression was significantly lower in the patients with CAA（P =0.031）, while the level of RAGE expression was significantly higher（P =0.015）.Conclusion CAA is one of the key reasons leading to the disease of ICH. The abnormal expression of RAGE and LRP1 may play a vital role in the pathogenesis of CAA associated ICH.

关 键 词：脑淀粉样血管病 自发性脑出血 低密度脂蛋白受体相关蛋白1 晚期糖基化终产物受体 

分 类 号：R743.34[医药卫生—神经病学与精神病学]