对脑出血血肿周围组织病理学改变及ICAM-1表达的研究

目的研究大鼠脑出血血肿周围组织病理学改变及ICAM-1的表达。方法选用健康雄性SD大鼠84只（由河北医科大学实验动物中心提供）,随机分为3组,A组：正常对照组（Norm）,n=14,SD大鼠购回后正常饲养,无手术操作。B组：假手术组（Sham）,n=14,操作过程同出血组,但不注血,操作2 h后断头取脑。C组：出血组（Model）,n=56,按脑出血后不同时间分为4个亚组（C1、C2、C3、C4）,即分别为脑出血后6 h、12 h、24 h、48 h,每个亚组的大鼠分别为14只。对于C组大鼠脑出血模型制备采用自体血注入法。3组大鼠分别于相应时间点处死,制备切片后作组织化学染色和常规染色,以观察不同时间点血肿周围病理学改变及ICAM-1的表达变化。结果光镜病理观察：出血6 h组于血肿周围可见变性坏死区域,细胞排列不整齐,核形态不整,部分核皱缩。髓质可见片状间质水肿,但未见炎性细胞浸润。出血12 h组除可见变性坏死区域扩大外,细胞周围出现空白区,细胞分布不均匀,神经元细胞数减少,可见散在淋巴细胞浸润。出血24 h组可见组织水肿明显,神经元细胞数明显减少。可见细胞崩解小体、中性粒细胞、淋巴细胞浸润及中性粒细胞附壁现象。假手术组和正常对照组未见异常变化。细胞间粘附分子-1（ICAM-1）表达变化：出血组从出血12 h组开始ICAM-1表达的积分光密度和面密度明显升高,与相应时间点的假手术组和正常对照组比较,经单因素方差分析有显著性差别（P〈0.01）。出血6 h组与假手术组及正常对照组比较无显著性差异（P〉0.05）。假手术组和正常对照组比较没有显著性差异（P〉0.05）。结论脑出血后血肿周围炎性反应及ICAM-1均参与了继发性损伤的发生。在脑出血的发生发展和转归过程中起到一定作用。

Study on pathology and expression of ICAM-1 around the hematoma

Objective To study the pathology and expression of ICAM-1 around the hematoma.Methods 84 healthy male SD adult rats were selected,and were divided into 3 groups randomly： Group A： Norm group（Norm）,its number was 14.They were feed normally.There was no operation on them.Group B： sham group（Sham）,its number was 14.We only exposed the rats＇ anterior fontanelle,but didn＇t inject blood.Tow hours later,we sacrificed the rats and took their brain.Group C： Model group（Model）,its number was 56.Model group was further divided into 4 groups with 6h、12h、24h、48h after ICH.Each group＇s number was 14.In Group C,the model was made by using intracranial injecting with their own blood.Each group＇s rats were then sacrificed on time and their brains were immediately removed to make cerebral tissue.HE method of staining was used to observe the histopathologic change around the hematoma and immunohistochemical tinction was applied to detect the expression of ICAM-1.Results Pathology observation through light microscope： In 6h group of model,deteriorative and necrotic area around the hematoma appeared and the cells ranked disorderly.The nucleus＇ form was irregular,partly pyknosis.There was no interstitial edema in medullary substance.But there was no inflammatory cell infiltration.In 12h group of model,deteriorative and necrotic area expanded.Blankarea around the cells appeared and the cells ranked unhomogeneously.Neuron cells reduced.Some inflammatory cells infiltrated.In 24h group of model,interstitial edema was more obviously.Neuron cells reduced more than 12h group,and the cytoclasis corpusculum,neutrophil and lymphcells infiltrated.We could see parietal neutrophils.Group A and Group B were normal.The expression of ICAM-1： ICAM-1 began to rise from 12h group of model and had significant difference by one-way ANRON（P〈0.01）compared with the corresponding time point of Norm and Sham group.In 6h group of model,expression of ICAM-1 had no significant difference compared with Norm and Sham group（P〉0.05）.There was no significant difference between Norm and Sham group（P〉0.05）.Conclusion Inflammatory respond and ICAM-1 take part in the secondary injury of the ICH.They affect the invasion、development and the prognosis of the ICH.