Bais Babette, Kubat Bela, Motazedi Ehsan, Verdijk Robert M
Department of Pathology, Section Ophthalmic Pathology, ErasmusMC University Medical Center Rotterdam, Rotterdam, Netherlands; Department of Forensic Medicine of the Netherlands Forensic Institute, The Hague, Netherlands.
Department of Forensic Medicine of the Netherlands Forensic Institute, The Hague, Netherlands; Department of Pathology, Maastricht University Medical Center, Maastricht, Netherlands.
Am J Ophthalmol. 2015 Dec;160(6):1285-1295.e6. doi: 10.1016/j.ajo.2015.09.005. Epub 2015 Sep 14.
To investigate β-amyloid precursor protein (β-APP), ubiquitin, and glial fibrillary acid protein (GFAP) immunostaining as a diagnostic tool to aid in the discrimination between abusive head trauma and nonabusive head trauma in postmortem ocular histopathologic investigation.
Retrospective cross-sectional study.
Seventy-four eyes of 37 infants were studied for hemorrhage and immunohistochemical expression of β-APP, ubiquitin, and GFAP in the retina and optic nerve. Infants were assigned to abusive head trauma or control groups, according to published criteria.
In the abusive head trauma group, positive β-APP and ubiquitin immunostaining of the retina was significantly more likely to be found than in the control group, odds ratio (OR) 11.4, confidence interval (CI) 2.9-44.3; P < .001 and OR 8.8, CI 2.2-34.5; P = .002, respectively. Positive correlations were found between retinal expression of β-APP and ubiquitin immunostaining and retinal hemorrhage. Vitreal hemorrhages, orbital fat hemorrhages, and macular folds could only be identified in abusive head trauma cases. Retinal hemorrhages were significantly more severe, occupied a larger proportion of the retina, and involved more retinal layers in abusive head trauma compared to controls (OR 2.7, CI 1.7-4.4; P < .001).
This study shows correlations between positive retinal β-APP and ubiquitin immunostaining as a sign of axonal injury in abusive head trauma. Axonal injury is a useful pathologic feature that can be demonstrated in postmortem ocular investigation of deceased children using immunohistochemical staining for β-APP and ubiquitin with a high OR for abusive head trauma when compared to controls.
研究β-淀粉样前体蛋白（β-APP）、泛素和胶质纤维酸性蛋白（GFAP）免疫染色作为一种诊断工具，以协助在尸检眼部组织病理学研究中鉴别虐待性头部外伤和非虐待性头部外伤。
回顾性横断面研究。
对37例婴儿的74只眼睛进行研究，观察视网膜和视神经中的出血情况以及β-APP、泛素和GFAP的免疫组化表达。根据已发表的标准，将婴儿分为虐待性头部外伤组或对照组。
在虐待性头部外伤组中，视网膜β-APP和泛素免疫染色呈阳性的情况比对照组更常见，优势比（OR）分别为11.4，置信区间（CI）为2.9 - 44.3；P <.001和OR 8.8，CI为2.2 - 34.5；P =.002。β-APP和泛素免疫染色的视网膜表达与视网膜出血之间存在正相关。玻璃体积血、眶脂肪出血和黄斑褶皱仅在虐待性头部外伤病例中被发现。与对照组相比，虐待性头部外伤中的视网膜出血明显更严重，占视网膜的比例更大，累及的视网膜层次更多（OR 2.7，CI 1.7 - 4.4；P <.001）。
本研究表明，视网膜β-APP和泛素免疫染色阳性与虐待性头部外伤中的轴突损伤迹象相关。轴突损伤是一个有用的病理特征，在对已故儿童进行尸检眼部研究时，使用β-APP和泛素免疫组化染色可以显示出来，与对照组相比，虐待性头部外伤的优势比很高。
