类胰蛋白酶和类糜蛋白酶表达在过敏反应死亡与冠心病猝死者组织中的表达

Expression of tryptase and chymase in anaphylactic death and sudden coronary death and their significance in forensic medicine

目的探讨类胰蛋白酶(tryptase)和类糜蛋白酶(chymase)在过敏反应死亡中表达及其与过敏反应死亡和冠心病猝死的关系,为过敏反应死亡的病理诊断和法医学鉴定提供新的形态学依据。方法从本教研室2008—2011年尸检档案中挑选病例70例,并搜集其原始档案资料、福尔马林固定包埋的心脏及肺脏蜡块,复阅HE切片。分为四组:A组:冠心病猝死(SCD,20例);B组:冠心病非猝死者(CHD,20例);C组:过敏性猝死(10例);D组:阴性对照(无明显动脉粥样硬化病变的死者,20例)。应用免疫组化染色(SP法)和图像定量分析法,观察每例肺脏、心脏的类胰蛋白酶和类糜蛋白酶染色情况和光密度。结果 SCD组、CHD组、过敏反应死亡组缺血心肌及肺脏内tryptase表达的OD值均高于阴性对照组,各组间比较均有显著差异(P<0.05)。肺脏内chymase表达的OD值在SCD组、CHD组和过敏反应死亡组均大于阴性对照组(P<0.05),SCD组、CHD组和过敏反应死亡组两两比较均无统计学意义(P>0.05)。结论类糜蛋白酶虽然在过敏反应死亡和冠心病猝死时表达有增强,但是表达量比较少,两者之间基本相同,该蛋白酶作为鉴别过敏反应死亡和冠心病猝死证据尚不充分。类胰蛋白酶在过敏反应死亡和冠心病猝死心和肺表达显著增强,可以作为过敏反应死亡和冠心病猝死医学鉴别的重要参考指标之一。

Objective To investigate the relationship between the expression of tryptase and ehymase with anaphylactic death and sudden coronary death （SCD） , and their diagnostic significane in forensic pathology. Methods Autopsy heart and lung samples （n = 70） collected during 2008 -2011 in our department were divided into 4 groups. Group A （20cases） died of sudden death with coronary heart disease （SCD） ; group B （20 cases）, non - sudden death with coronary heart disease ; group C （10cases） died of anaphylaxis sudden death;Group group D： 20 cases died of any cause without atherosclerosis. Tryptase and chymase were detected by immunohistochemistry （SP method） and image analysis. Results The O D values of trypase in the ischemie myoeardium and lung tissue were significantly higher in SCD, CHD, sudden anaphylactic death groups than that in the control group, with statistically significant differences among the groups （P 〈 0.05）. The OD values of chymase in the lung tissue were significantly higher in the SCD, CHD and sudden anaphylactic death groups than that in the control group, showing statistically significant differences among the groups （P 〈 0.05）. There were no significant differences between each two groups among the SCD, CHD and sudden anaphylactic groups （P 〉 0.05）. Conclusions Chymase protein level is increased in sudden coronary death （SCD） and anaphylactic death patients. However, chymase only accounts for 3% of the total protein in mast cells, and the expression of this protease is not sufficient as an evidence to identify anaphylactic death and coronary heart disease death. Tryptase is in- creased in the heart and lung of sudden coronary death （SCD） and anaphylactic death patients, and could be used as an important reference for medical identification of sudden death from anaphylaxis and coronary heart＂ disease.