原发性脑干损伤致死病理学观察

Pathologic and immunohistochemical study on lethal primary brain stem injury

目的观察原发性脑干损伤的组织病理变化，探讨其在脑干损伤致死诊断中的意义。方法收集1993年1月至2008年6月间明确死于原发性脑干损伤和脑外疾病者共65例，分为损伤组（25例）和对照1组（死于心血管疾病20例）、对照2组（死于非心血管疾病20例）。通过对中脑、脑桥和延脑切片，HE染色光镜下观察，银染色及免疫组织化学sP法进行胶质纤维酸性蛋白（GFAP）、神经丝蛋白（NF）、β-淀粉样物质、髓磷脂碱性蛋白染色观察。并在100倍光镜下，采用显微测微器每个部位测量10条免疫组织化学NF染色最粗的纵行神经轴突最粗处横径，对所得数据作统计学处理。结果与对照组相比，损伤组脑干的挫伤、星形细胞反应、水肿、神经细胞等病变均有差异（P〈0．05）。浅表挫伤最易发部位是中脑；内部挫伤中脑发生为21例（84％），桥脑为18例（72％），延脑为14例（56％）；星形细胞反应中脑发生为14例（56％），桥脑为7例（28％），延脑为12例（48％）；水肿中脑发生为4例（16％），桥脑为6例（24％），延脑为14例（56％）；神经细胞病变中脑发生为22例（88％），桥脑为19例（76％），延脑为16例（64％）；小胶质细胞增生中脑发生为15例（60％），桥脑为9例（36％），延脑为13例（52％）。神经轴索出现特征性的改变，损伤组与对照组相比，脑干的轴索肿胀程度差异有统计学意义。损伤组轴突直径（4．91±0．73）μm，对照1组（3．95±0．73）μm，对照2组（3．83±0．68）μm（F=20．70，P〈0．05）。结论多种组织病理变化对原发性脑于损伤的尸解病理诊断有一定的价值，通过测量轴突横径，为脑干损伤导致死亡的死因诊断提供了一种可参考的量化指标。

Objective To study the histopathologic changes of primary brain stem injury and to investigate their significance in the diagnosis of primary brain stem injury. Methods Sixty-five autopsy cases died of primary brain stem injury and other diseases were enrolled into this study. The cases were subdivided into brain stem injury group （n = 25 ） and control group （including 20 cases died of cardiovascular disease and 20 cases died of non-cardiovascular diseases ）. The brain stem tissue sections were stained with hematoxylin-eosin and silver impregnation techniques. Immunohisto chemical study for glial fibrillary acidic protein, neurofilament, amyloid-β and myelin basic protein was carried out. The widest cross diameters of l0 axons highlighted by immunostaining were measured in each low power field （ × 100 ） through light miscroscopy in all the cases studied. Results In comparing with that of the control group, there were differences in the degree of contusion lesion, reactive astroeytosis, edema and pathologic changes of neuronal cells present in the brain stem injury group and was statistically significant （ P 〈 0. 05 ）. The axons locating in the brain stem injury group showed a distinctive histology by the appearance of significantly larger diameters （P 〈 0. 05 ）. Conclusions Primary brain stem injury demonstrates certain distinctive histopathologic changes and measurement of axonal diameters provides an additional quantitative index useful in autopsy diagnosis.