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系統識別號 U0026-0812200912020689
論文名稱(中文) 靜脈注射滑石粉引發肺部間質疾病及動脈栓塞的病理變化
論文名稱(英文) Pathological modulation in the intravenous talc-induced pulmonary interstitial disease and arterial embolism
校院名稱 成功大學
系所名稱(中) 細胞生物及解剖學研究所
系所名稱(英) Institute of Cell Biology and Anatomy
學年度 94
學期 2
出版年 95
研究生(中文) 周欣燕
研究生(英文) Shin-Yen Chou
學號 t9693106
學位類別 碩士
語文別 中文
論文頁數 56頁
口試委員 口試委員-蕭開平
口試委員-蔡崇弘
指導教授-曾啟育
指導教授-簡基憲
口試委員-靳應臺
中文關鍵字 異物栓塞  滑石粉  海洛因  濫用藥物  賦型劑  肺動脈栓塞 
英文關鍵字 talcosis  illicit drug  foreign body embolism  heroin  crystal 
學科別分類
中文摘要 毒品中的海洛因,時常摻雜包括滑石粉、錠劑之賦型劑等各種不溶於血液中之雜質來降低純度。藥物濫用者也將口服毒品錠劑研磨成粉在溶於溶劑後的直接注射。故藥物濫用者,利用針頭注射含有雜質的毒品藥物經血液循環導致動脈栓塞,在呼吸系統極易導致異物性的肉芽腫甚至肺氣腫,造成缺氧進而引發呼吸衰竭導致死亡。法務部法醫研究所剖檢國內因藥物濫用致死的案件中發現,多數器官中均可見到異物栓塞,以呼吸系統尤甚。在肺下葉的細小動脈中更有類似結晶物質的栓塞,肺呈現慢性發炎及纖維化、異物性肉芽腫及動脈病變等,極易導致呼吸衰竭而死亡。本研究的目的在於收集、分析國人因靜脈注射濫用藥物致死的肺組織病理變化,並建立動物實驗模式。以靜脈注射滑石粉引起肺動脈栓塞,並連續觀察各時期肺組織的病理變化,再與國人因靜脈注射濫用藥物剖檢的肺部病變相互比較。我們篩選18-34歲青壯年人口中有煙毒前科,因靜脈注射濫用藥物而導致呼吸衰竭死亡的剖檢案例,將肺部組織用H & E染色在光學顯微鏡及偏光顯微鏡下觀察發現,肺動脈及間質皆有結晶物質,肺實質有嚴重慢性發炎、肉芽腫及纖維化。在動物實驗上,將SD rat每公克體重由尾靜脈注射1.0 mg及0.2 mg滑石粉,分別在急性期、亞急性期及慢性期觀察肺部組織。在高劑量組中,實驗鼠在注射後24小時內死亡,肺動脈管有大量結晶物質栓塞。在低劑量組的急性期中發現有動脈結晶栓塞及急性炎症反應,在亞急性期中肺實質出現慢性發炎反應,動脈管的中層增厚,結晶物質移至肺部間質。慢性期中有肉芽腫出現及肺間質纖維化及血管再管化。以電子顯微鏡觀察可見肺間質中的膠原纖維增多及排列不規則。Type Ⅱ 肺泡細胞中的lamillar body 有異常增多及溶解的現象。綜合以上結果可藉由動物實驗的靜脈注射滑石粉引起肺動脈栓塞,再連續觀察各時期肺的病理變化期能建立本土化的資料庫。


英文摘要 Illicit substance abusing can affect the anatomical compartment of lung to produce unique morphological profile. Foreign body embolism and granulomatosis with re-cannulization are the major histopathology of the vascular complication of lung in intravenous drug abusers (Glassroth et al., 1987) . The most important cause of foreign body emboli is the intravenous injection of contaminated heroin and mixed with aqueous suspensions of pharmaceutical tablets intended for oral consumption. Embolic foreign body granulomatosis may cause dyspnea, mild hypoxaemia, and result respiratory failure (Tomashefski et al., 2004). Clinical reports of the severe interstitial fibrosis, arterial embolism and focal edema were found in the lung tissue by autopsy of drug abuser in Institute of Forensic Medicine, Institute of Ministry of Justice (Taiwan) (Shaw KP et al., 1996).The purpose of this study is to collect and analysis autopsy case because the drug abuses death and establish an animal model by intravenous injection of various sizes of foreign materials such as talc to evaluate the pathological changes of lung tissue vs. time course. Observing the lung tissue of autopsy case, have chronic inflammation and granuloma and interstitial fibrosis, and can find the smaller crystal fill in the blood vessel and interstitial tissue. In animal model, adult male Sprague-Dawley rats were intravenous injection of talc 1 and 0.2 mg/gm body weight via tail vein. The high-dose (1 mg/gm body weight) talc in rats, can produce 100% mortality of rats within 24 h intravenously right instantaneously. This phenomenon is attributed to the mechanical occlusion of pulmonary artery by the instilled talc particles. However the low-dose (0.2 mg/gm body weight) talc in rats, the acute stage (1 day survival) shows arterial embolism and acute inflammatory response in lung tissue. The pulmonary vessels are filled with crystals. During subacute stage (1-2 week survival), shows chronic inflammation and pulmonary artery medial hypertrophy. The small granules of crystal migrate to interstitial tissue. Interstitial fibrosis and granulomatosis in the chronic stage (1-2 month survival) are observed. The smaller crystal within interstitial fibrosis with scanty giant cell infiltration, granulomatosis and vascular recannulization are noted. Find in the TEM the lamillar body in the type Ⅱ pneumocytes transforms, the collage fibers within the interstitial cell unusually increases and piles up. Establishment of animal model mimic the illicit drugs-induced fatalities can play a crucial rule to elucidate the pathological findings and can develop the strategy of the anti-illicit drug war.


論文目次 一、 緒論………………………………………1
二、 材料與方法………………………………6
三、 實驗結果…………………………………12
四、 討論………………………………………17
五、 結論………………………………………24
六、 圖表與說明………………………………25
七、 參考文獻…………………………………49
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