87例新生儿羊水吸入死亡案例法医病理学分析

Forensic pathological analysis of 87 death cases of amniotic fluid inhalation in newborns

目的通过对87例新生儿羊水吸入死亡案例进行法医病理学检查与分析,探讨在法医病理学新生儿尸体检验鉴定中对新生儿吸入的羊水成分对肺泡表面活性物质分泌的影响。方法选取2014年1月至2018年1月济宁医学院附属济宁市第一人民医院及济宁医学院司法鉴定中心鉴定的87例新生儿羊水吸入死亡案例为AFI组,31例非羊水吸入死亡案例为对照组,常规HE染色观察羊水成分,免疫组织化学SP法检测SPA、SP-B蛋白在肺组织中的表达情况。结果 AFI组细支气管及肺泡腔内均可见多量红染的胎粪样小体、毳毛及角化上皮等羊水成分;AFI组SP-A阳性表达率为40.2%,SP-B阳性表达率为41.4%,与对照组相比阳性表达率显著降低,差异具有统计学意义(χ2SP-A=10.549,P<0.05;χ2SP-B=11.878,P<0.05);羊水吸入与SP-A、SP-B分泌量呈相关性(rSSP-A=-0.818,P<0.005;rSSP-B=-0.829,P<0.005)。结论羊水成分吸入量和肺泡表面活性物质分泌量之间有相关性,羊水成分的存在会抑制或减少肺泡表面活性物质分泌。

Objective Through the forensic pathology examination and analysis of 87 cases of neonatal amniotic fluid inhalation, the relationship between the maturity of lung tissue development and the composition of amniotic fluid and the secretion of surfactant in the newborn was discussed. Methods A total of 87 cases of neonatal amniotic fluid inhalation death identified by Jining No. 1 Peopleg Hospital ＆ the Affiliated Hospital of Jining Medical University and the Judicial Expertise Center of Jining Medical University from January 2014 to January 2018 were selected as AFI group and 31 cases of non-amniotic fluid inhalation death as control group （ wax block）. Routine HE staining was used to observe the components of amniotic fluid, and the ex- pression of SP-A and SP-B protein in lung tissue was detected by immunohistochemical SP method. Results A large number of red-stained meconium-like bodies, velvet hair and keratinizing epithelium were found in the bronchioles and alveolar cavities of AFI group. The positive expression rate of SP-A and SP-B in AFI group was 40.2% and 41.4% respectively, compared with control group. The expression rate was significant- ly decreased （ 2 2 x^2SP-A = 10. 549 ,P 〈 0.05 ; x^2SP-A= 11. 878 ,P 〈 0.05 ）. The amniotic fluid inhalation was significantly correlated with SP-A,SP-B secretion （ rSSP-A = - 0. 818,P 〈 0.05 ; rSSP-A = - 0. 829,P 〈 0.05 ）. Conclusion There is a correlation between amniotic fluid components inhalation and alveolar surfactant secretion. The presence of amniotic fluid components inhibits alveolar surfactant secretion.