【作者】 卫志燕；

【导师】 高彩荣；

【作者基本信息】 山西医科大学 ， 法医学， 2009， 硕士

【摘要】 目的:通过测定21例急性心肌梗死患者、63例各种机械性损伤患者,及21例对照组血浆中类胰蛋白酶含量,研究急性心肌梗死及各种机械性损伤对血浆类胰蛋白酶含量的影响。为中国免疫正常人群血浆类胰蛋白酶含量的正常值范围做补充,为过敏性疾病和过敏性猝死提供客观、准确的依据;同时测定了上述105例血浆中类糜蛋白酶的活性,研究心肌梗死及各种损伤患者血浆中类糜蛋白酶活性与类胰蛋白酶含量的关系;观察类胰蛋白酶和类糜蛋白酶在过敏猝死者肺组织的表达,为过敏性猝死的法医学鉴定提供可靠的形态学依据。方法:实验分组为:急性心肌梗死组、下肢骨折组、颅脑损伤、胸部损伤、对照组,每组各21例。(1)使用UniCAP 100过敏原自动检测仪,利用荧光免疫酶技术(FEIA)测定105例血浆中类胰蛋白酶的含量。(2)使用Thermo酶标仪测定105例血浆类糜蛋白酶活性。(3)采用荧光免疫双染法对过敏猝死者肺组织内类胰蛋白酶和类糜蛋白酶进行染色,采用OLYMPUSOLS的Image Analyze及Image-pro plus软件对所取图象进行图像分析,计阳性细胞数和荧光表达强度。结果:(1)105例血浆类胰蛋白酶含量测定结果为:急性心梗组为1.59±0.59μg/L、下肢骨折组为3.87±1.62μg/L、颅脑损伤组为3.51±0.85μg/L、胸部损伤组为3.79±1.50μg/L、对照组为2.97±1.05μg/L。对照组、急性心肌梗死组、下肢骨折组、颅脑损伤组、胸部损伤组与健康中国人血浆类胰蛋白酶含量算术平均数3.06μg/L进行单样本t检验。对照组与健康中国人血浆类胰蛋白酶含量算术平均数3.06μg/L差异无统计学意义(P＞0.05)。颅脑损伤组血浆类胰蛋白酶含量与健康中国人血浆类胰蛋白酶含量算术均数3.06μg/L差异无统计学意义(P＞0.05)。急性心肌梗死组、下肢骨折组、胸部损伤组血浆类胰蛋白酶含量与健康中国人血浆类胰蛋白酶含量算术平均数3.06μg/L差异有统计学意义(P＜0.05)。(2)实验组及对照组血浆类胰蛋白酶含量与血浆类糜蛋白酶活性有相关性(P＜0.05)。(3)类胰蛋白酶和类糜蛋白酶荧光免疫双染结果为:阳性细胞数值实验组为28.9±5.78,对照组为1.40±1.07(P＜0.05);荧光强度数值实验组为94.8±2.74,对照组为0.87±0.54(P＜0.05),表明当过敏猝死发生时,类胰蛋白酶与类糜蛋白酶表达增强。结论:(1)急性心肌梗死可影响机体血浆类胰蛋白酶含量。颅脑损伤不会影响机体类胰蛋白酶含量;胸部损伤及下肢骨折可导致类胰蛋白酶含量轻度增高。血浆类胰蛋白酶含量可以作为过敏性猝死法医学鉴定的指标之一。(2)类糜蛋白酶活性与类胰蛋白酶含量有相关性。(3)过敏猝死者肺组织内类胰蛋白酶与类糜蛋白酶表达增高。更多还原

【Abstract】 Objective:To complement Chinese healthy individuals’ range of normal values of plasma tryptase levels through detecting 63 traumatic patients,21 acute myocardial infraction and 21 control group plasma tryptase levels,and to provide diagnoses supporting for anaphylaxis and anaphylactic shock;An investigation on the acute myocardial infraction and traumatic patients’ plasma tryptase levels and plasma chymase activity,to find the relationship of the tryptase and the chymase in the plasma of traumatic patients;To explore the expression of tryptase and chymase in the pulmonary tissues of the human sudden erethistic death,trying to seek objective morphological reference support to diagnose sudden anaphylactic death for forensic medicine.Methods:Dividing experiment samples into five groups:the acute myocardial infarction(AMI) group,the fracture of lower limb group,the craniocerebral wounds group,the thoracic injuries group and the control group,there are 21 plasmas in every group.(1) Measuring plasma tryptase levels by the UniCAP 100 instrument(Pharmacia Diagnostics AB,Uppsala,Sweden).(2) Measuring plasma chymase activity by the enzyme-labelling measuring instrument(Thermo Electron Corporation,America).(3) tryptase and chymase were stained using fluoroimmunohistochemistry method,and the images of tryptase and chymase were analyzed by Image Analyze and Image-pro plus of OLYMPUSOLS.The positive cells were count.The levels of the tryptase and chymase was calculated.Result:(1) The level of tryptase in the control group is 2.97±1.05μg/L.The level of tryptase in the AMI is 1.59±0.59μg/L.The level of tryptase in the fracture of limb is3.87±1.50μg/L.The level of tryptase in the craniocerebral wounds is 3.51±0.85μg/L.The level of tryptase in the thoracic injuries is 3.79±1.50μg/L.Comparing with the arithmetic mean of plasma tryptase(3.06μg/L), the control group and the craniocerebral wound have no statistical significance(P>0.05).The AMI has statistical significance(P<0.05).The fracture of limb and the thoracic injuries have statistical significance(P<0.05).(2) the activity of chymase is related to the level of the tryptase(P<0.05).(3)There was a statistically significant difference(P<0.05) for the positive cell of the tryptase and chymase concentrations in the pulmonary tissues of the human between the group of anaphylactic shock(28.9±5.78) and the control groups(1.40±1.07).There was a statistically significant difference(P<0.05) for the tryptase and chymase concentrations in the pulmonary tissues of the human between the group of anaphylactic shock(94.84±2.74) and the control groups(0.87±0.54). Conclusion(1)AMI can influence the level of tryptase.The craniocerebral wounds don’t influence the level of tryptase,the fracture of limb and the thoracic injuries cause the level of tryptase increased lightly.(2)The activity of chymase is related to the level of the tryptase in all groups.(3)The level of the tryptase and the activity of chymase were greatly enhanced in the pulmonary tissues of human with anaphylactic shock.更多还原