Nielsen Henning, Thomsen Jørgen L, Kristensen Ingrid B, Ottosen Peter D
Department of Medical Biochemistry, University of Aarhus, Aarhus, Denmark.
Pathology. 2003 Aug;35(4):305-10. doi: 10.1080/0031302031000150551.
The present study was initiated by a very recent histochemical observation of lipid accumulation in the renal cortex of a woman who died in a diabetic coma. Two older reports of lipid accumulation in the kidneys of patients who died, most likely in a state of non-regulated diabetes, supported this observation. We have examined whether lipid accumulation in the renal cortex is characteristic of diabetic coma and, if so, which type of lipid accumulates.
Three groups were studied. Ten subjects who died in a diabetic coma, eight diabetics who died of known causes unrelated to diabetes, and seven normal control subjects without any diagnosed diabetes who died of known causes. All were subjected to histological examination for lipid accumulation in the renal cortex. Detailed analysis of cortex lipids was performed for two of the subjects who died in a diabetic coma and all diabetic controls as well as non-diabetic control subjects.
All subjects who died in a diabetic coma showed vacuolar lesions staining strongly for lipid in the proximal tubules. Neither normal controls nor non-coma diabetics showed these lesions. Compared with normal controls, renal cortex lipid was about tripled in the two analysed diabetic coma subjects due to 60-100-fold increases of triglycerides. The non-coma diabetics did not differ from the other controls with respect to triglycerides or other types of lipid, except that cholesteryl esters were elevated, though still a quantitatively minor component.
Our findings strongly indicate that vacuolar lesions in the proximal tubules are characteristic of diabetic coma and that they are caused by accumulated triglycerides. Therefore, histological examination of renal cortex using a lipid stain may be a useful forensic tool in establishing diabetic coma as the cause of death.
本研究始于最近一项组织化学观察，该观察发现一名死于糖尿病昏迷的女性肾皮质中有脂质蓄积。另外两篇关于死于糖尿病（很可能处于未控制状态）患者肾脏脂质蓄积的旧报告支持了这一观察结果。我们研究了肾皮质中的脂质蓄积是否为糖尿病昏迷的特征，若如此，蓄积的是哪种类型的脂质。
研究了三组对象。十名死于糖尿病昏迷的受试者、八名死于已知非糖尿病相关病因的糖尿病患者以及七名无糖尿病诊断且死于已知病因的正常对照受试者。对所有受试者的肾皮质进行组织学检查以检测脂质蓄积情况。对两名死于糖尿病昏迷的受试者以及所有糖尿病对照和非糖尿病对照受试者的皮质脂质进行了详细分析。
所有死于糖尿病昏迷的受试者近端小管均出现脂质染色强阳性的空泡样病变。正常对照和非昏迷糖尿病患者均未出现这些病变。与正常对照相比，两名经分析的糖尿病昏迷受试者的肾皮质脂质增加了约两倍，这是由于甘油三酯增加了60至100倍。除了胆固醇酯升高（尽管在数量上仍是次要成分）外，非昏迷糖尿病患者在甘油三酯或其他类型脂质方面与其他对照无差异。
我们的研究结果有力地表明，近端小管中的空泡样病变是糖尿病昏迷的特征，且由蓄积的甘油三酯引起。因此，使用脂质染色对肾皮质进行组织学检查可能是确定糖尿病昏迷为死因的一种有用的法医工具。
