肥厚型心肌病左心室心肌纤维化及骨桥蛋白表达变化

摘要

目的 研究肥厚型心肌病(hypertrophic cardiomyopathy,HCM)死者心肌间质纤维组织含量及心肌细胞中骨桥蛋白的表达,探讨骨桥蛋白在鉴定HCM致死案件中的法医学意义.方法 选取15例HCM致死者左心室心肌为HCM组、15例冠心病心肌肥厚致死者左心室心肌为冠心病组及20例交通事故及高坠致死者左心室心肌为对照组,应用HE染色、Masson三色染色法和免疫组化法比较3组左心室心肌间质中胶原容积分数及心肌细胞内骨桥蛋白阳性表达的变化,并利用图像分析软件进行统计学分析. 结果 HCM组和冠心病组左心室心肌间质胶原容积分数高于对照组(P＜0.05),而HCM组与冠心病组差异无统计学意义(P＞0.05)；HCM组和冠心痛组左心室心肌细胞骨桥蛋白阳性表达积分光密度值均高于对照组(P＜0.05),且HCM组高于冠心病组(P＜0.05). 结论 心肌间质胶原纤维含量的增高和骨桥蛋白过度表达可能在HCM心肌纤维化过程中发挥重要作用,可作为HCM致心源性猝死的辅助诊断指标.%Objective To investigate the changes of collagen fibers and the expression of osteopontin in the left ventricle in cases of hypertrophic cardiomyopathy (HCM), along with the significance of their potential forensic application. Methods Fifteen cases of HCM, 15 cases of coronary heart disease with cardiac hypertrophy and 20 cases of traffic accidents were selected as HCM group, coronary heart disease group and control group, respectively. Collagen volume fraction and osteopontin expression were observed and compared by HE staining, Masson trichrome staining and immunohistochemistry methods. Imaging and statistical methods were used for quantitative analysis. Results Collagen volume fraction in left ventricle of HCM and coronary heart disease were significantly higher than that in the control group (P<0.05), which was not significantly different between the HCM group and the coronary heart disease group. The integral light density value of osteopontin in left ventricular cardiomyocytes of the HCM group and the coronary heart disease group were significantly higher than that of the control group (P<0.05), and the value of the HCM group was also significantly higher than that of coronary heart disease group (P<0.05). Conclusion The increased contents of collagen fibers and the overexpression of osteopontin may play an important role in myocardial fibrosis, and they can be used as markers in aid of diagnosing sudden death due to HCM.