三种特殊组织化学染色在急性心肌缺血猝死病例中的对比研究

Comparative Study of Three Special Histochemical Stains in Sudden Acute Myocardial Ischemia

摘要: 目的：探讨三种组织化学染色方法在急性心肌梗死中的染色规律及其在心肌梗死早期的形态变化上的应用价值。方法：采用HE染色、Nagar-Olsen染色、Heidenhain染色(铁矾–苏木素–伊红染色)和Heidenhain氏苏木精法染色，对9例建模成功的急性心肌梗死大鼠心脏标本和15例急性心肌梗死猝死者心肌标本进行染色，并设5例正常大鼠心肌标本和5例假手术组大鼠心肌标本作为对照。结果：Nagar-Olsen染色、Heidenhain染色、Heidenhain氏苏木精法染色在急性心肌梗死心肌中阳性表达率分别为75%、54%、50%，在正常心肌组表达均呈阴性。对35例标本均进行了HE染色，结果显示细胞核的改变只在梗死区出现，在非梗死区心肌纤维表现为细胞水肿，胞质红染，胞核无明显病变，很难与对照组心肌鉴别。上述三种方法在组间的阳性表达率比较未见差异(P > 0.05)。但急性心肌梗死组与假手术组及对照组阳性表达率比较差异有统计学意义(P < 0.01)。各组均行HE染色，显示在梗死区出现细胞核的改变，在非梗死区心肌纤维表现为细胞水肿，胞质红染，胞核无明显病变，与对照组心肌很难鉴别。结论：Nagar-Olsen染色、Heidenhain染色、Heidenhain氏苏木精染色在急性心肌缺血猝死诊断中均有应用价值，在实际工作中可以通过HE染色结合Heidenhain氏苏木精法染色以提高诊断率；通过HE染色结合Nagar-Olsen染色确定梗死区的范围。

Abstract: Objective: To investigate the staining regularity of three histochemical staining methods in acute myocardial infarction and their application value in the morphological changes in the early stage of myocardial infarction. Methods: HE staining, Nagar-Olsen staining, Heidenhain staining and Heidenhain’s hematoxylin staining were used to stain the cardiac 9 cases of successful acute myocardial infarction rat heart specimens and 15 patients with sudden death due to acute myocardial infarction. The myocardial specimens of 5 normal rats and 5 sham rats were used as control. Results: The positive expression rates of Nagar-Olsen staining, Heidenhain staining and Heidenhain’s hematoxylin staining in the myocardium of acute myocardial infarction were 75%, 54% and 50%, respectively, and the expression in normal myocardial group was negative. HE staining was performed on all 35 specimens, and the results showed that the changes in the nucleus only occurred in the infarct area. In the non-infarct area, the myocardial fibers showed cellular edema, cytoplasmic red staining, and no obvious lesions in the nucleus, which was difficult to differentiate from the myocardium in the control group. Conclusion: Nagar-Olsen staining, Heidenhain staining and Heidenhain’s hematoxylin staining have application value in the diagnosis of acute myocardial ischemic sudden death. In practice, HE staining combined with Heidenhain’s hematoxylin staining can improve the diagnostic rate. HE staining combined with Nagar-Olsen staining was used to determine the extent of the infarct.