脑出血患者血肿周围组织炎性反应与细胞凋亡的相关性研究

Study of relationship between inflammatory response and apoptosis in perihematoma region in patients with intracerebral hemorrhage

目的探讨脑出血患者血肿周围组织炎性反应与细胞凋亡的关系。方法对30例手术的脑出血患者于血肿旁约1cm处取少许脑组织作为试验组，按发病到手术的时间将试验组分为〈6h（6例）、6～12h（7例）、12～24h（5例）、24～72h（6例）、〉72h（6例）。从前两组中选7例患者于手术入颅路径上远隔血肿处取少许脑组织作为对照组。应用苏木素-伊红（HE）染色、免疫组化染色、末端脱氧核苷酸转移酶介导的dUTP缺口末端标记法（TUNEL）、逆转录-聚合酶链反应（RT—PCR）分别观察组织病理、炎性细胞浸润和小胶质细胞增生、凋亡细胞、促凋亡基因（Bax）、抗凋亡基因（Bcl-X）的变化情况。结果光镜观察显示：对照组和试验组6h内脑组织基本正常，试验组6～12h损伤较轻，12～24h损伤较重，24～48h损伤严重，以后逐渐好转，8d时与对照组相似。免疫组化显示：中性粒细胞、淋巴细胞、巨噬细胞浸润从6～12h逐渐明显，12～24h达高峰（P均〈0．01），小胶质细胞增生从24～72h开始，72h以后明显增强（P均〈0．01）；凋亡细胞、Bax蛋白表达从6～12h开始增加，12～24h达高峰（P〈0．05或P〈O．01）。Bcl—X蛋白及其mRNA表达从12～72h有增加的趋势，但差异无显著性。RT—PCR显示：Bax mRNA表达与免疫组化结果相似；相关分析显示：中性粒细胞、淋巴细胞、巨噬细胞浸润和小胶质细胞增生与凋亡细胞、Bax蛋白和BaxmRNA表达呈显著正相关（P〈0．05或P〈0．01）．与Bcl—X蛋白及其mRNA表达无相关性（P均〉0．05）。结论脑出血后血肿周围组织的炎性反应与细胞凋亡关系密切，并与组织病理损伤相一致。

Objective To investigate the relationship between inflammatory response and cell apoptosis in the perihematoma region in patients with intracerebral hemorrhage （ICH）. Methods Surgieal speeimens were obtained from the area 1 em ad}aeent to the hematoma. Thirty patients with ICH were divided into five groups： 6, 7, 5, 6, 6 patients in surgery〈6 hours, 6-12 hours, 12- 24 hours, 24- 72 hours and 〉72 hours groups after the onset, respeetively. The eontrol group speeimens were obtained from the brain tissues distant to the hematoma in the process of eraniotomy in the patients of two former groups. Seetions were stained with hematoxylin and eosin （ HE ） for the examination of pathologieal ehanges. Immunohistoehemistry, terminal deoxynueleotidyl-transferase mediated dUTP-biotin nick end labeling （TUNEL） and reverse transcription-polymerase chain reaetion （RT- PCR） were applied to determine apoptosis eells, Bax and Bel -x protein and mRNA. Results The tissues from perihematoma region were almost normal in eontrol group and 〈6 hours group. They were slightly damaged in 6 - 12 hours group, beeame worse in 12- 24 hours group and most severe in 24 -48 hours group, and they became better latter and were similar to the control group on 8 th day. Infiltration of neutrophils, maerophages and lymphoeyte appeared gradually at 6- 12 hours, and became much more prominent at 12- 24 hours （all P〈0. 01）. The reactive gliosis began to appear at 24 - 72 hours, and enhanced after 72 hours （all P〈0. 01）. The expression of the apoptosis and Bax protein inereased gradually after 6 hours, reaching the peak at 12 - 24 hours （P〈0. 05 or P〈0. 01）, and decreased gradually later. The changes in the levels of Bax mRNA were similar to that of the result of immunohistoehemistry. Although the expression of Bel - x protein and mRNA seemed to be inereased at 12- 72 hours, there was no significant difference between groups （P〉0.05）. The eorrelation analysis showed that the infiltration of neutrophils, macrophages and lymphoeyte was positively correlated to the TUNEL positive cells and expression of Bax protein and mRNA （P〈0. 05 or P〈0. 01）, and showed no correlation to Bcl - x protein and mRNA （all P 〉 0. 05）. Conclusion There is a close relationship between inflammatory response and apoptosis and tissue damage in the perihematoma area in ICH.