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目的对比检测不同损伤程度和损伤后不同时间脑外伤患者的水通道蛋白4(AQP4)的表达差异,探讨AQP4与临床预后的关系。方法 94例急性创伤性脑损伤患者手术清除脑组织标本为研究对象。根据术前格拉斯哥(GCS)评分将患者分为不同的程度损伤组,其中中度损伤组(GCS评分9~12分)36例,重度损伤组(GCS评分3~8分)42例,特重度损伤组(GCS评分低于3分)16例,另外根据患者受伤后距住院的时间差不同将患者分为三组,≤6 h组51例,6~12 h组24例,≥12 h组19例。取手术清除的创伤区脑组织标本,用免疫组化法检测不同损伤程度以及损伤后不同时间的AQP4的表达情况。结果 1.中度损伤组患者脑组织标本在光镜下观察脑细胞以及血管内皮细胞轻度肿胀;重度以及特重度损伤组脑细胞和血管内皮细胞明显肿胀,血管周围间隙明显增宽,损伤时间越长,脑组织以及血管内皮损伤越严重。2.脑组织中AQP4阳性表达信号为细胞膜或细胞浆棕黄色染色。随损伤程度加重,AQP4表达增强,在特重度损伤组AQP4表达最强(0.336±0.037 OD),高于重度损伤组(0.237±0.031 OD)和中度损伤组(0.185±0.024 OD),比较差异均有统计学意义(P<0.05)。3.随着伤后时间的延长,损伤部位脑组织AQP4表达量逐渐增多。≥12 h组AQP4表达最强(0.436±0.038 OD),高于6~12 h组(0.297±0.021 OD)和≤6 h组(0.213±0.034 OD),比较差异有统计学意义(P<0.05)。结论急性创伤性脑外伤脑组织中AQP4的表达强度与脑损伤病情程度密切相关,抑制AQP4的活性有可能减轻脑损伤后脑水肿的程度。
Objective To compare the expression of aquaporin 4 (AQP4) in patients with traumatic brain injury at different time points after injury and at different time points after injury, and to explore the relationship between AQP4 and clinical prognosis. Methods 94 cases of acute traumatic brain injury in patients with brain tissue removed for the study. According to the preoperative Glasgow (GCS) score, patients were divided into different groups, including 36 cases with moderate injury group (GCS score 9-12), 42 severe injury group (GCS score 3-8) The patients in the injury group (GCS score less than 3) were divided into three groups according to the difference in time from hospitalization after injury, 51 patients in ≤6 h group, 24 patients in 6-12 h group and ≥12 h group example. Tissue specimens from the traumatic area were collected and the expression of AQP4 was detected by immunohistochemistry at different degrees of injury and at different time points after injury. The brain tissue samples of mild injury group were observed under light microscope, mild swelling of brain cells and endothelial cells; severe and severe severe injury of brain cells and vascular endothelial cells were significantly swollen, significantly increased perivascular space, injury time The longer, the more serious the damage of brain tissue and vascular endothelial. AQP4 positive expression signal in brain tissue was cytoplasmic brown or cytoplasmic staining. Compared with severe injury group (0.237 ± 0.031 OD) and moderate injury group (0.185 ± 0.024 OD), the expression of AQP4 was increased with the severity of injury, and the expression of AQP4 was the strongest in the severe injury group (0.336 ± 0.037 OD) All were statistically significant (P <0.05). With the extension of time after injury, the expression of AQP4 in brain tissue gradually increased. The expression of AQP4 in the group of ≥12 h was the highest (0.436 ± 0.038 OD), higher than that in the group of 6-12 h (0.297 ± 0.021 OD) and ≤6 h (0.213 ± 0.034 OD), the difference was statistically significant (P <0.05 ). Conclusion The expression of AQP4 in brain tissue of acute traumatic brain injury is closely related to the severity of brain injury. Suppression of AQP4 activity may reduce the severity of brain edema after brain injury.