缺氧缺血性脑病新生儿神经细胞凋亡及星形胶质细胞的变化

目的 探讨HIE患儿神经细胞凋亡与星形胶质细胞(AST)的变化.方法 HIE死亡新生儿25例.男14例,女11例.对25例HIE患儿脑病理标本进行大体观察、光镜观察,原位末端TUNEL法观察神经细胞凋亡,免疫组织化学观察胶质原纤维酸性蛋白(GFAP)标记的AST水平的变化,分析其与HIE发生、病程的关系.采用方差分析和q检验进行分析.结果 HIE患儿25例大体标本均存在脑膜紧张,软脑膜血管充盈、淤血,脑回增宽变平,脑沟变窄.切面湿润,血管扩张,点状或小灶性出血.光镜观察脑标本均可见神经细胞凋亡,大脑以存活24 h～6 d神经细胞凋亡程度重(P<0.05),小脑以存活3 d内神经细胞凋亡程度重(P<0.05),延髓以存活24 h～3 d神经细胞凋亡程度最重(P<0.05);脑标本均可见AST增生,小脑AST表现为生后24 h内死亡者增生程度重(P<0.05),生存时间越长,增生程度反而越轻;慢性缺氧时大脑AST增生程度重(P<0.05),急性缺氧时延髓增生程度重(P<0.05),混合性缺氧大脑及延髓增生程度均较重(Pa<0.05).结论 HIE新生儿神经细胞凋亡及AST增生程度在不同脑区明显不同,且与HIE的发生及病程密切相关.

Alteration of Apoptosis and Astrocyte in Neonatal Hypoxic-Ischemic Encephalopathy

Objective To observe the alteration of astrocyte and apoptosis in neonatal hypoxic-ischemic encephalopathy(HIE).Me-thods The pathological brain specimens of 25 newborns who died of HIE were observed macroscopically and microscopically,included male 14 cases and female 11 cases.The immunochemistry staining with glial fibrillary acidic protein(GFAP)and in situ end terminal dexynucleotidy 1 transferase mediated deoxyuridine triphosphate-biotion nick and labeling(TUNEL)methods were used to observe the changes of astrocyte and the neurons apoptosis in HIE.The relationship between the change of astrocyte and the neurons apoptosis and the occurrence of HIE and course of disease were further synthetically analyzed.Results The brain specimens of 25 newborn HIE had apoptosis cells at the different level.The degree of apoptosis of cerebral neurons was severe in the cases of 24 h-6 d survival(P<0.05).The degree of apoptosis of cerebellar neurons was severe in the cases of 3 d survival and that of oblongata neurons was severe in the cases of 24 h-3 d survive(P<0.05).All the pathological brain specimens had astrocyte hyperplasia of difference degrees.Cerebellar hyperplasia showed that hyperplasia was severe in the cases who died within 24 h(P<0.05),the longer were surviving time the less hyperplasia it showed.Cerebral and medulla oblongata astrocyte hyperplasia was independent of survival time.Cerebral astrocyte hyperplasia in the chronic incomplete hypoxia cases was severe(P<0.05).The change of medulla oblongata in the acute complete hypoxia cases was severe(P<0.05).The change of cerebral cortex and medulla oblongata were all severe in the cases of mixed hypoxia(Pa<0.05).Conclusion The changes of neurons apoptosis and the degree of astrocyte hyperplasi are closely related to the occurrence and course of disease in neonatal hypoxic-ischemic encephalopathy.