法医学杂志

法医学杂志 ›› 2018, Vol. 34 ›› Issue (4): 352-358.DOI: 10.12116/j.issn.1004-5619.2018.04.002

• 论著 • 上一篇    下一篇

血栓形成时间的推断

杨琛腾，左  敏，王松军，刘  霞，马如飞，齐  倩，毕海涛，李英敏，张国忠   

  1. 河北医科大学法医学院 河北省法医学重点实验室，河北 石家庄 050017
  • 发布日期:2018-08-25 出版日期:2018-08-28
  • 通讯作者: 张国忠，男，博士，教授，主任法医师，硕士研究生导师，主要从事法医病理学、法医临床学、法医法学的教学与研究；E-mail：zhanggz3@126.com
  • 作者简介:杨琛腾（1988—），男，硕士研究生，主要从事法医病理学和法医临床学研究；E-mail：yccy0928@126.com
  • 基金资助:
    河北省科学技术资助项目（142777108D）

Estimation on Formation Time of Thrombus

YANG Chen-teng, ZUO Min, WANG Song-jun, LIU Xia, MA Ru-fei, QI Qian, BI Hai-tao, LI Ying-min, ZHANG Guo-zhong   

  1. Hebei Key Laboratory of Forensic Medicine, College of Forensic Medicine, Hebei Medical University, Shijiazhuang 050017, China
  • Online:2018-08-25 Published:2018-08-28

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摘要： 目的 观察大鼠静脉血栓形成时间的变化规律，为血栓致死的法医学案件中关于血栓形成时间推断提供新的思路与方法。 方法 80只大鼠随机分为术后0 h、3 h、6 h、12 h、1 d、3 d、1周、2周、3周、4周组共10组，通过“狭窄法”建立大鼠静脉血栓模型，采用HE染色、Perls染色、Von Kossa染色观察血栓形成、机化和再通过程中含铁血黄素、钙盐的变化特点，并运用免疫组织化学染色方法检测CD61、α-SMA、CD34的表达变化。 结果 术后3 h血小板黏附于裸露血管内膜，术后1 d血小板反复堆积形成血小板小梁，术后3 d管壁增生、成纤维细胞长入血栓内部、血栓机化，内皮细胞覆于血栓表面形成新的血管，血流重建再通。血栓形成3 h及血栓再形成时期（4周） CD61表达，并于血栓形成1 d达其峰值；血栓形成3 d含铁血黄素析出、α-SMA开始表达；血栓形成1周钙盐沉着、CD34阳性表达出现。 结论 含铁血黄素、钙盐、CD61、α-SMA和CD34在血栓形成过程中均出现时间依从性变化特点，有望为血栓致死的法医学案件关于血栓形成时间的推断提供参考。

关键词: 法医病理学, 血栓形成, 含铁血黄素, CD34, CD61, &alpha, -SMA, 钙盐

Abstract: Objective To observe the changes of the formation time of venous thrombus in rats, and to provide new ideas and methods for the estimation on thrombus formation time of the forensic cases died from thrombosis. Methods Totally 80 rats were randomly divided into 10 groups （0 h, 3 h, 6 h, 12 h, 1 d, 3 d, 1 week, 2 weeks, 3 weeks and 4 weeks after operation）. A vein thrombosis model was established by the “narrow” method. The processes of thrombosis, organization, recanalization and the features of change on hemosiderin and calcium salt were observed by HE stain, Perls stain and Von Kossa stain. The expression changes of CD61, α-SMA and CD34 were observed by immunohistochemical staining technique. Results Platelets adhered to the exposed blood vessel intima 3 h after operation, and platelet trabeculae were formed by the repeated accumulation of platelets 1 d after operation. The thrombus organization formed through the fibroblasts from vessel wall that grew into the interior of the thrombus 3 d after operation. Endothelial cells covered the surface of thrombus and then the new blood vessels were reformed, and the vessels were reconstructed. The expression of CD61 upregulated at the stages of the thrombus formation （3 h） and thrombus reformation （4 weeks）, and reached the peak 1 d after thrombus formation. The release of hemosiderin and the initial expression of α-SMA were detected 3 d later. Calcium deposit and expression of CD34 were observed 1 week later. Conclusion The hemosiderin, calcium salt, CD61, α-SMA and CD34 show time-dependent changing characteristics, which is expected to provide a reference for the estimation on thrombus formation time of the forensic cases died from thrombosis.

Key words: forensic pathology, thrombosis, hemosiderin, CD34, CD61, α-SMA, calcium salt