高血压脑出血血肿周围脑组织细胞色素C表达及其与脑水肿的关系

STUDY ON RELATIONSHIP OF CYTOCHROME C EXPRESSION AND CEREBRAL EDEMA IN PERIHEMATOMA BRAIN TISSUE OF PATIENTS WITH HYPERTENSIVE CEREBRAL HEMORRHAGE

目的探讨高血压脑出血患者血肿周围脑组织细胞色素C的表迭及其与血肿周围脑组织损伤与水肿形成的关系。方法2001年9月-2002年9月住院的34例高血压脑出血患者，脑出血量25-80ml，年龄35-75岁，住院行微创血肿抽吸术治疗。在微创血肿抽吸术过程中获得血肿周围脑组织，采用HE染色、组织病理学观察及免疫组织化学技术测定其细胞色素C的表迭。根据术前头颅CT测量脑出血患者血肿周围脑水肿带的大小，用双盲法对染色结果及术前脑水肿的体积进行分析。结果脑出血12-72h血肿周围脑组织均出现不同程度的水肿，广泛性脱髓鞘．神经元皱缩，核固缩．并有凋亡小体形成；脑出血后4h，血肿周围组织已出现细胞色素C的表达，脑出血后48～72h，细胞色素C的表达达到高峰。细胞色素C表达强阳性（16例）组、弱阳性（13例）组、阴性（5例）组之间比较，脑水肿体积的差异有统计学意义（P〈0．01）。结论细胞色素C在高血压脑出血血肿周围组织中表迭上调．可能参与了血肿周围脑组织的损伤与水肿的形成。

Objective To investigate the expression of cytochrome C in perihematomal brain tissue and its relationship with histopathological change and formation of cerebral edema in patients with hypertensive cerebral hemorrhage. Methods 34 patients aged 35-75 with hypertensive cerebral hemorrhage were studied. The volume of hemorrhagic blood was 25-85 ml. They were in hospital from Sep. 2001 to Sep. 2002. The perihematomal brain tissue was obtained from the minimally invasive surgery. Histopathological change and expressions of cytochrome C in perihematomal brain tissue was detected by histopathological and imunohistochemical techniques. The volume of perihematomal cerebral edema was determined by computed tomographic scan before operation. The results of staining and the volume of perihematomal cerebral edema were analyzed in double blind fashion. Results Perihematomal cerebral edema were found at 12-72h after cerebral hemorrhage. Myelin sheath degeneration, condensation of nucleus and typical apopototic body were observed in perihematomal brain tissue. Expression of cytochrome C in perihematomal brain tissue were observed at 4h and reached peak in 48-72h after cerebral hemorrhage. The expression of cytochrome C were strongly positive in 16 patients, weak positive in 13 patients, negative in 5 patients. There were significant difference in volume of perihematomal cerebral edema with different expression of cytochrome C in perihematomal brain tissue （P〈0. 01）. Conclusion The expression of cytochrome C is upregulated in perihematomal brain tissue in patients with hypertensive cerebral hemorrhage. Cytochrome C may involve in the histopathological change and the formation of perihematomal cerebral edema.