水通道蛋白-4在脑挫裂伤灶周围组织的表达及其与创伤性脑水肿的关系  

Expression of aquaporin 4 in contused brain tissue and its relationship with brain edema

作　　者：周和平[1,2] 陈新生[2] 施正生[2] 查正江[2] 苏忠周[3] 李向东[1] 

机构地区：[1]苏州大学附属第一医院神经外科,215006 [2]安徽医科大学附属安庆医院神经外科 [3]湖州市中心医院神经外科

出　　处：《中华创伤杂志》2017年第2期159-163,共5页Chinese Journal of Trauma

基　　金：安徽医科大学校科学研究基金（2015xkj066）

摘　　要：目的观察颅脑创伤患者脑挫裂伤灶周围组织水通道蛋白-4（AQP-4）表达及其与创伤性脑水肿的关系。方法采用回顾性病例对照研究分析2015年1月-2016年3月收治的重度颅脑损伤手术患者42例，其中男23例，女19例；年龄23-62岁[（35．5±5．6）岁]。格拉斯哥昏迷评分（GCS）3—5分7例，6—8分23例，9-10分12例。取脑挫裂伤灶周旁1cm处脑组织作为研究组（42例），远隔脑挫裂伤处需内减压清除的脑组织作为对照组（8例）。电镜下观察两组脑组织标本病理超微结构。伤后〈6h、6—12h、12-24h、24—72h、72—96h和〉96h，采用于一湿重法检测两组标本脑组织含水量；免疫组织化学法检测两组标本脑组织AQP-4表达水平。结果对照组脑组织形态和结构基本正常，研究组细胞内及间质水肿明显，形态结构受损。对照组脑组织含水量未见明显增加（73．55±0．10）。与对照组比较，研究组脑组织含水量明显增加，伤后24-72h达到峰值（81．28±0．56）（P〈0．01）。对照组脑组织AQP-4表达未明显增加（0．193±0．016）。与对照组比较，研究组AQP-4表达水平明显升高，伤后6h表达开始增高（0．242±0．023），24—72h达到峰值（0．338±0．013）（P〈0．05）。相关性分析显示，脑组织含水量变化与AQP-4的表达水平呈明显正相关（r=0．931，P〈0．01）。结论颅脑创伤后损伤区AQP-4表达明显升高、脑组织含水量增多，提示损伤区AQP-4表达与创伤性脑水肿密切相关。Objective To observe the expression of aquaporin 4 （AQP-4） in contused brain tissue and its relationship with brain edema following brain trauma. Methods A retrospective case control analysis was made on 42 patients with severe brain trauma admitted from January 2015 to March 2016. There were 23 males and 19 females, aged from 23 to 62 years [ （35.5 ＋5.6）years]. Glasgow coma score （GCS） was 3-5 points in 7 patients, 6-8 points in 23 and 9-10 points in 12. Brain tissue removed from the area 1 cm near the contusion during the cranial surgery were allocated to study group （n = 42）, while brain tissue removed far from the contusion after internal decompression were used as control （n = 8）. Uhrastructure of brain tissues was observed under electron microscope. Water content of brain tissue was measured by dry-wet weight method and expression of AQP-4 was measured by immunohistochemical method at postinjury hours 〈 6, 6-12, 12-24, 24-72, 72-96 and 〉 96. Results Morphology and structure of brain tissue in control group were normal. Whereas in study group, the intracellular and interstitial edema were obvious and morphological structure were damaged. Water content and AQP-4 expression in control group showed no obvious increase after operation（73.55±0.10, 0. 193±0. 016）. Water content in study group increased significantly compared to control group and reached the peak value （81.28±0. 56） at postinjury 24-72 hours （P 〈 0.01 ）. AQP-4 expression in study group increased at postinjury 6 hours （0. 242 ± 0. 023 ） and reached a peak at postinjury 24-72 hours （0. 338 ± 0. 013 ） , with significant difference compared to control group （ P 〈 0.05 ）. Correlation analysis showed change of brain water content was positively correlated with expression level of AQP-4 （r = 0. 931 ,P 〈 0.01 ）. Conclusion Expression of AQP-4 in the injured area of brain trauma is significantly increased along with the increase of water content, suggests that the upregulation of AQP-4 plays a

关 键 词：颅脑损伤 脑水肿 水通道蛋白质4 超微结构 

分 类 号：R651.15[医药卫生—外科学]