脑挫伤后损伤侧与非损伤侧脑组织病理变化及其意义

摘要

目的 探讨大鼠脑挫伤后损伤侧与非损伤侧脑组织病理变化及其意义. 方法 选择健康成年Wistar大鼠100只,按随机数字表法分为假手术组和挫伤组,各组又分为1,3,6,12,24 h5个时相点,每个时相点10只大鼠.各时相点取脑组织分别行挫伤处及非挫伤处病理形态学观察,IgG免疫组化染色半定量分析检测血脑屏障(blood brain barrier,BBB)通透性. 结果 假手术组双侧脑组织结构未见异常,IgG染色阴性.挫伤组损伤侧伤后1h即出现以BBB破坏为特征的血管源性水肿,3h出现细胞内水肿,两种水肿均随时间延长逐渐加重.挫伤后12 h后开始出现组织坏死、炎性细胞浸润及小胶质细胞增生.伤后1 h IgG开始呈阳性,6h最强,维持高水平至24 h.而挫伤组非损伤侧伤后1h结构未见异常,IgG染色阴性.3h后出现细胞内水肿,IgG染色弱阳性.6h后细胞内水肿加重,同时出现血管源性水肿,IgG染色呈强阳性.12～24 h细胞内水肿仍继续加重,而血管源性水肿有缓解趋势,IgG染色减弱,并见小胶质细胞增生. 结论 脑挫伤后损伤侧与非损伤侧病理改变有差异,可为脑挫伤治疗方法选择提供依据.%Objective To investigate the pathological changes of brain tissues from contused and contralateral non-contused sides and their significance.Methods A total of 100 healthy adult Wistar rats were assigned to brain contusion group and sham operation group according to the random number table.Ten rats in each group were sacrificed at 1,3,6,12,and 24 hours respectively.Brain samples were collected to perform pathophysiological analysis of brain tissues and test blood brain barrier (BBB)permeability by semiquantitative immunohistochemical staining of IgG.Results There was no damage to the bilateral brain tissues in sham operation group and IgG stain was negative.In brain contusion group,angioedema characterized by the breakdown of BBB was seen in the contused side at 1 hour followed by cellular edema at 3 hours,with aggravation of both over time.Moreover,tissue necrosis,inflammatory cell infiltration,and microglia proliferation emerged at 12 hours.Besides,IgG-positive staining was seen at 1 hour,was strongest at 6 hours,and remained a high level at 24 hours.With respect to the non-injured side in brain contusion group,no pathological abnormalities and negatively stained IgG were observed at 1 hour; cellular edema and weakly positive-stained IgG were found at 3 hours; aggravated cellular edema,emergence of angioedema,and IgG strongly positive staining were noted at 6 hours;cellular edema continued aggravation,but angioedema tended to be attenuated,IgG staining weakened,and microglia proliferation were observed at 12-24 hours.Conclusion Pathological changes of brain tissues from the contused and contralateral non-contused sides are differed,which provides a basis in determining treatment choices.