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目的 探讨用组织学方法界定脑梗死患者脑组织缺血性半暗带的可行性。方法 对 7例脑梗死病例的尸检大脑进行MRI的T2 图像分析 ,并观察脑组织大 /小切片、神经元、小胶质细胞、星形细胞、血管、细胞骨架 (MAP2 、NF2 0 0 )以及部分细胞因子 ;按损伤程度将病灶分为 0～ 3区 ,研究不同区域的特点。结果 0区的神经元、胶质细胞和血管皆坏死 ,可出现嗜伊红神经元 ,细胞骨架消失 ;1区可见大量缺血的暗神经元及皱缩神经元 ,细胞骨架严重破坏 ,有小胶质细胞激活等炎细胞反应 ;2区可见部分缺血变化的神经元、暗神经元和形态正常的神经元 ,有星形细胞和小胶质细胞反应 ,细胞骨架正常或改变轻微 ;缺血 2d内 2区面积迅速减小 ,此时MRI显示的病灶小于组织大切片证实的病灶 ,只显示 0区和 1区病灶 ,不显示 2区病灶。 3区细胞形态正常 ,有小胶质细胞激活、星形细胞增生、转化生长因子 (TGF)表达增加以及肿瘤坏死因子α(TNFα)阳性表达 ,持续存在于全部病例的病灶周边。结论 0区、1区为中心坏死区。结合MRI、细胞和细胞骨架变化可以推断 ,2区为半暗带等值区 ;3区为损伤反应区 ,有些文献称之为“半暗带”。
Objective To investigate the feasibility of defining ischemic penumbra of brain tissue in patients with cerebral infarction by histological method. Methods MRI images of 7 autopsy brains of cerebral infarction patients were analyzed by T2-weighted imaging. The histopathological changes of brain were analyzed by MRI, Part of cytokines; according to the degree of injury lesions will be divided into 0 to 3 areas, study the characteristics of different regions. Results Neurons, glial cells and blood vessels in zone 0 were necrotic, eosinophilic neurons and cytoskeleton disappeared. In zone 1, a large number of ischemic dark neurons and collapsed neurons were found. The cytoskeleton was severely damaged and small Glial cells activation and other inflammatory cell reactions; 2 areas can be seen part of the ischemic neurons change, dark neurons and normal morphological neurons, astrocytes and microglia reaction, cytoskeleton normal or slightly changed; ischemia The area of area 2 decreased rapidly in 2 days. At this time, the lesions showed by MRI were smaller than those confirmed by large sections of tissues, showing only the lesions in zone 0 and zone 1, but not in zone 2. The morphology of cells in zone 3 was normal with microglial activation, astrocytosis, increased expression of transforming growth factor (TGF) and positive expression of tumor necrosis factor alpha (TNFa), persisting in the peritumoral lesions of all cases. Conclusion Area 0 and area 1 are the central necrosis area. With the change of MRI, cell and cytoskeleton, it can be inferred that zone 2 is the penumbra equivalent zone; zone 3 is the injury response zone, and some literature calls it “penumbra zone”.