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| 87例新生儿死亡案例法医病理学分析 |
| Forensic Pathological Analysis of 87 Death Cases of Amniotic Fluid Inhalation in Newborns |
| 投稿时间：2018-09-06 修订日期：2018-09-29 |
| DOI： |
| 中文关键词: 法医病理学；尸体检验；新生儿窒息；羊水吸入；肺泡表面活性物质；免疫组织化学 |
| 英文关键词: Forensic pathology; Autopsy; Neonatal asphyxia; Amniotic fluid inhalation; Pulmonary surfactant; Immunohistochemistry |
| 基金项目: |
| 作者 | 单位 | 邮编 | | 邵玉铭 | 济宁医学院司法鉴定中心 | 272067 | | 李国良 | 济宁医学院司法鉴定中心 | | | 丁润涛 | 济宁医学院司法鉴定中心 | | | 王旭 | 济宁医学院司法鉴定中心 | | | 马莉* | 济宁医学院附属济宁市第一人民医院 | 272011 |
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| 中文摘要: |
| 通过对87例新生儿羊水吸入死亡案例进行法医病理学检查与分析，探讨在法医病理学新生儿尸体检验鉴定中对新生儿吸入的羊水成分对肺泡表面活性物质分泌的影响。方法 收集2014年1月至2018年1月济宁市第一人民医院及济宁医学院司法鉴定中心鉴定完毕的87例新生儿羊水吸入和非羊水吸入死亡案例标本（蜡块），先常规HE染色观察羊水成分，后采用免疫组织化学SP法，检测SP-A、SP-B蛋白在肺组织中的表达情况。结果 87例新生儿羊水吸入死亡案例中均查见羊水成分，与对照组相比，AFI组细支气管及肺泡腔内均可见多量红染的胎粪样小体、毳毛及角化上皮等羊水成分；AFI组SP-A阳性表达率为40.2%，SP-B阳性表达率为41.4%，与对照组相比阳性表达率显著降低，差异具有统计学意义（2SP-A=10.549，P<0.05；2SP-B=11.878，P<0.05）；羊水吸入与SP-A、SP-B分泌量呈显著相关性（rS SP-A=-0.818、P＜0.05；rS SP-B=-0.829、P＜0.05）。结论 羊水成分吸入量和肺泡表面活性物质分泌量之间有相关性，羊水成分的存在会抑制或减少肺泡表面活性物质分泌。 |
| 英文摘要: |
| Through the forensic pathology examination and analysis of 87 cases of neonatal amniotic fluid inhalation, the relationship between the maturity of lung tissue development and the composition of amniotic fluid and the secretion of surfactant in the newborn was discussed. Methods A total of 87 cases of neonatal amniotic fluid inhalation death cases (wax blocks) were collected from the first people's Hospital of Jining and the Judicial Expertise Center of Jining Medical University from January 2014 to January 2018. Routine HE staining was used to observe the components of amniotic fluid, the expression of SP-A and SP-B protein in lung tissue was detected by immunohistochemical SP method. Results Amniotic fluid components were found in 87 cases of neonatal amniotic fluid inhalation death. Compared with the control group, a large number of red-stained meconium-like bodies, velvet hair and keratinizing epithelium were found in the bronchioles and alveolar cavities of AFI group; the positive expression rate of SP-A and SP-B in AFI group was 40.2% and 41.4% respectively, compared with control group. The expression rate was significantly decreased (2SP-A=10.549, P<0.05; 2SP-B=11.878, P<0.05); amniotic fluid inhalation was significantly correlated with SP-A, SP-B secretion (rS SP-A=-0.818, P<0.05; rS SP-B=-0.829, P<0.05). Conclusion There is a correlation between amniotic fluid components inhalation and alveolar surfactant secretion. The presence of amniotic fluid components inhibits or decreases alveolar surfactant secretion. |
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