心脏型脂肪酸结合蛋白诊断心肌缺血性猝死

Heart-type Fatty Acid-Binding Protein as a Marker for Diagnosis of Cardiac Sudden Death

目的 :研究心肌缺血后不同时间段心肌细胞胞浆内心脏型脂肪酸结合蛋白 (H FABP)含量变化的规律 ,并与肌红蛋白 (Mb)对比 ,为法医病理学诊断心肌缺血所致的猝死提供形态学依据。方法 :按Selye法结扎大鼠左冠状动脉前降支复制早期心肌缺血动物模型。用免疫组织化学方法 ,观察心肌缺血后不同时间H FABP和Mb在心肌细胞中含量的改变。结果 :三个不同对照组均无明显H FABP脱失 ,但穿线不结扎组有少量的Mb脱失。早期心肌缺血 15min时 ,缺血区心肌即可出现H FABP和Mb缺失 ,随着缺血时间的延长 ,二者缺失的范围扩大 ,程度加重 ,从心内膜下向外层心肌发展呈“波浪式推进现象” ,与对照组相比均有显著性差异。二者的缺失面积在 4h组出现显著性差异。结论 :心肌缺血后 15min即可出现H FABP脱失 ,H FABP脱失可用于心肌缺血所致的心源性猝死的诊断。

Objective: To provide morphologic evidence for the forensic pathologists to diagnose sudden death from early myocardial ischemia(EMI),and to compare the content of heart-type fatty acid binding-protein(H-FABP) in rats' myocardial cells,at different stages of acute myocardial ischemia,with that of myoglobin(Mb). Methods: The rat model of myocardial ischemia was induced by ligating the anterior branch of the left coronary artery following the method of Selye. The content of H-FABP and Mb were detected with immunohistochemisty respectively. Results: There was no statistical difference among three control groups for H-FABP. As for Mb,the nuance between sham oclusion of coronary artery group and the other two control groups was found. It was observed that both H-FABP and Mb depletion occured in ischemia area in 15 min myocardial ischemia group. Along with the ischemia time,the wavy-like advance of depleting H-FABP and Mb,both in size and intensity,from subcardium to subepicardium could be found. There was obvious statistical difference between ischemia groups and control groups for H-FABP and Mb. The depletion area of H-FABP was different from that of Mb only in the 4 h myocardial ischemia group. Conclusion: The distinct depletion of H-FABP in 15 min myocardial ischemia group can be used in the diagnosis of the sudden death from myocardial ischemia.