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观察新生儿缺氧缺血性基底节损伤 (BGI)的病理特点、探讨多巴胺转运蛋白 (DAT)和多巴胺D2受体 (D2R)变化与急性缺氧缺血性BGI的关系。光镜检查 63例HIE死亡患儿脑HE染色标本 ,并用免疫组化链酶菌抗生物素蛋白 -过氧化物酶连结法 (简称S -P法 )检查 1 8例急性缺氧缺血性BGI的DAT和D2R的变化。结果显示 :42 9%(2 7/63 )的HIE患儿有BGI,其中急性BGI 1 8例 ,慢性BGI 9例。在早产儿 ,急性BGI主要表现为神经元核裂解 ,而在足月儿主要表现为神经元嗜酸性变 ,组织坏死在早产儿比足月儿更明显。 1 8例急性BGI中 ,7例相对轻的BGI病例 ,其基底节的神经元和神经纤维对DAT免疫反应增强 ,而 8例较重的BGI病例 ,其基底节的神经元和神经纤维对DAT免疫反应减弱。在所有急性BGI病例 ,基底节D2R阳性神经元均减少 ,其减少的区域恰好与基底节损伤区域一致 ,减少的程度也与基底节损伤程度相平行。结论认为 ,早产儿和足月儿缺氧缺血性BGI的病理改变可能由于神经元的成熟性或和易损性不同略有差别 ,DAT和D2R参与了缺氧缺血性BGI,基底节对缺氧缺血易损可能与其神经化学解剖结构有关。
The pathological characteristics of neonatal hypoxic-ischemic basal ganglia (BGI) were observed and the relationship between dopamine transporter (DAT) and dopamine D2 receptor (D2R) and acute hypoxic-ischemic BGI was explored. Sixty-three HIE-dead children were examined by light microscopy for brain HE staining, and 18 cases of acute hypoxic-ischemic BGI were detected by immunohistochemical streptavidin-peroxidase-linked assay (S-P method) DAT and D2R changes. The results showed that 42 9% (2 7/63) children with HIE had BGI, including 18 cases of acute BGI and 9 cases of chronic BGI. In preterm infants, acute BGI is mainly manifested as neuronal nuclear lysis, while in term infants, neuronal eosinophilic changes are predominant, while tissue necrosis is more pronounced in preterm infants than full-term infants. In 18 cases of acute BGI, 7 cases of relatively mild cases of BGI showed enhanced immune response to DAT in the basal ganglia and nerve fibers, whereas in 8 cases of severe BGI, neurons and nerve fibers in the basal ganglia were negatively affected by DAT Immune response weakened. In all acute BGI cases, basal ganglia D2R-positive neurons were reduced, and the area of their reduction was coincident with the basal ganglia lesion area, which was also reduced to a degree parallel to the basal ganglia lesion. Conclusions: Pathological changes of hypoxic-ischemic BGI in preterm infants and term infants may be due to differences in neuronal maturity or vulnerability. DAT and D2R are involved in hypoxic-ischemic BGI, basal ganglia Hypoxic-ischemic vulnerability may be related to its neurochemical anatomy.