【作者】 幸宇；

【导师】 廖志钢；

【作者基本信息】 四川大学 ， 法医学， 2004， 硕士

【摘要】 研究背景及目的:在法医学实践中,历来对损伤时间的推断建立在创伤修复反应的病理生理学基础之上,即以不同经历时间的创口在修复过程中所表现的生活反应(vital reaction)特点——炎症反应、肉芽组织及上皮增生和疤痕修复所产生的各种形态、组化及生化变化特征作为推断损伤时间和性质的依据。机体损伤大多导致血管内皮的损伤,其直接后果是凝血过程的启动及其后的组织充血水肿,炎细胞浸润,组织修复再生等,其间von Willebrand Factor(vWF)对损伤血管内皮部位血小板的粘附聚集起到了重要作用;血管内皮生长因子(Vascular endothelial growth facto, VEGF)是作用最强,特异性最高的血管生成调控因子,在损伤的早期起到调节血管内皮细胞通透性,趋化炎细胞的作用,在修复期起改变细胞外基质,使其更易于血管的生长。在创伤的修复过程中,细胞—生长因子—细胞外基质(EcM, extracellular matrix)三者相互作用、相互影响的复杂动态过程,生长因子参与了创伤愈合的整个过程并在其中发挥着举足轻重的作用。创伤修复过程中,内源性生长因子起着重要的调控作用,因而检查创伤后机体内的凝血因子及生长因子的改变,使更加精确地推断损伤时间成为可能。 方法:健康Sprague-Dawley大鼠(S-D大鼠)65只,随机分为生前伤组、死后伤组和正常对照组,每组5只:生前伤组按处死时间不同分为15min、30min、1h、3h、6h、12h、1d、3d、5d、7d共十个亚组;更多还原

【Abstract】 Background and purpose: The estimation of time since injury is based on the plerosis responds of pathophysiology, which is the characteristic of vital reaction during the recovery of wound in different time section, including the character of morpholog and histochemistry and biochemistry changes of inflammation, granulation tissue, Epithelial proliferation and so on. These chatacteristics help forensic pathologists to evaluate the time since injury. The direct consequence of injury which usually cause damages to vascular endothelium are the chain reaction of blood coagulation, which takes place in the very first stage of hemostasis, then subsequently hyperemia ,edema and so on. von Willebrand Factor （vWF） plays a pivotal role in hemostasis , in which vWF contributes to both platelet adhesion/aggregation and bloodcoagulation through its multiple adhesive functions for the platelet membrane receptors, glycoprotein Ib-IX-V complex, integrin alphallbbeta3, heparin, various types of collagen, and coagulation factor VIII. Among various functions, the most characteristic feature of vWF is its determinant role on platelet thrombus formation under high-shear-rate conditions. Vascular endothelial growth factor （VEGF）, which promotes mobilization of stem cells to the circulation, contributing to the formation of functional vasculature. VEGF interacts with its receptors, VEGFR₂ and VEGFR₁, expressed on endothelial and hematopoietic stem cells, and thereby promotes recruitment of these cells to neo-angiogenic sites, accelerating the revascularization process. In progress of tissue plerosis, the endogenetic growth factors play important role of regulation. All these make it possible to estimate the time since injury by check the immediately change of coagulation factors and growth factors.Methods: Sixty-five Spragwe-Dawley rats were randomly divided into injury, posthumous injury and normal group, each group has5 rats. The injury group was divided into 10 subsections as 15min, 30min, lh, 3h, 6h, 12h, Id, 3d, 5d, 7d according to the time when put rats to death. The posthumous injury group was divided into 30min and lh two subsections, we use immunohistochemistry method and image analysis meter to study the expression of vWF and VEGF in the muscle.Results: （l）at the early stage of injury the expression of vWF in small artery and small vein is different: vWF expression in the endothelium cellof small artery was descent fast immediately after injury, and begin to increase by Id after injury, and come back to normal level by 3d after injury; in the same time, vWF expression in the endothelium cell of small vein goes another way, it increase significantly in the early stage of injury, and decrease slowly since 3h after injury, and go back to normal level by 3d after injury, but in general, the signal level of vWF of muscle tissue decreased immediately after injury, and then slowly come back to normal level. （2）VEGF expression increased immediately after injury, and reach the peak value and keep at a high level by 7d.Conclusion: Both VEGF and vWF change in the early stage of injury: VEGF expression increases and vWF expression decreases, and vWF remains at low level for a short period, the application of VEGF and vWF could be objective indication of extimation of time since injury.更多还原