吗啡类毒品中毒死亡者免疫组化染色观察

目的观察吗啡类毒品中毒死亡者不同组织的形态学及免疫组化改变。方法选取山西医科大学法医学院标本室内2例吗啡类毒品中毒死亡者作为实验组,1例冰毒中毒死亡者作为对照组,分别取心、脑、肺、肠组织进行HE染色,应用免疫组化SABC（Strept Avidin-Biotin Complex）法对各组类胰蛋白酶、类糜蛋白酶及黏附分子进行染色观察。结果吗啡中毒死亡者检材中HE染色观察到心肌纤维溶解、断裂,心肌细胞紊乱、水肿及纤维化;脑水肿,伴局灶性出血;明显肺水肿等病理表现。类胰蛋白酶、类糜蛋白酶及ICAM-1、VCAM-1免疫组化染色呈阳性表达,以肺及心肌组织为著。冰毒中毒死亡者检材免疫组化染色未见明显阳性颗粒。结论急性吗啡类毒品中毒死亡的主要表现与吗啡类药物引起的非变态反应性过敏反应中,肥大细胞脱颗粒释放类胰蛋白酶诱发肺泡基底膜降解、类糜蛋白酶促进心肌重塑等作用有关,而黏附分子表达升高对增强血管内炎症细胞附着与浸润发挥重要作用。

Observation of Immunohistochemical Staining for the Dead Poisoned by Morphines

Objective To observe the morphological and immunohistochemical changes of the different tissues for the dead poisoned by morphines.Methods 2 dead cases poisoned by morphines were collected from the Sample Room of Legal Medical College,Shanxi Medical University as an experimental group and 1 dead case poisoned by methamphetamine as a control group.The tissues from the heart,brain,lung and intestines were collected for HE staining separately.The immunohistochemical SABC method was adopted for the staining observation of tryptase,chymotrypsin and adhesion molecules in each group.Results For the tissues from the dead poisoned morphines,HE staining observation found the dissolution and fracture of myocardial fibers,and the disorders,edema and fibrosis of cardiocytes;brain edema combined with focal hemorrhage,obvious pulmonary edema,etc.The immunohistochemical staining of tryptase,chymotrypsin as well as ICAM-1 and VCAM-1 showed the positive expressions,which was especially significant in the tissues of the lung and myocardium.The immunohistochemical staining of the tissues from the dead poisoned by methamphetamine did not discover any obvious positive granules.Conclusion The main manifestations of the acute positioned dead by morphines and the non-allergic reaction induced by morphines are related with the degradation of alveolar basement membrane induced by tryptase released via mast cell degranulation and the cardiac remodeling promoted by chymotrypsin.The increasing expression of adhesion molecules plays the important role in enhancing the adhesion and infiltration of the intravascular inflammatory cells.