缩窄性心包炎法医学尸检鉴定1例

缩窄性心包炎引发猝死的法医病理学尸检鉴定目前国内鲜有报道,本文就1例于工作中因缩窄性心包炎致急性心力衰竭猝死的尸检案例进行分析,以供法医工作者于类似鉴定时参考.     

肥厚型心肌病分子机制及法医病理学意义

肥厚型心肌病(hypertrophic cardiomyopathy,HCM)被证实是引发35岁以下青年人(尤其是运动员心源性猝死(sudden cardiac death,SCD)的首要原因。约60%的HCM患者由编码肌小节蛋白的基因突变导致,呈常染色体显性遗传模式。β肌球蛋白重链基因、肌球蛋白结合蛋白C基因、肌钙蛋白T基因、肌钙蛋白I基因被认为是引起HCM最常见的突变基因。基因检测在HCM的临床诊断中已趋于常态化,但在法医工作中应用较少,如果基因检测技术能够应用于法医病理学诊断,将会给HCM猝死案件的死亡原因确认工作提供便利。更重要的是,通过猝死者的基因检测结果尽早进行家庭成员的危险评估才能降低猝死的发生率。本文主要综述了HCM的分子机制进展以及该疾病在法医病理学诊断中的应用价值。     

冠心病猝死的法医病理学免疫组织化学研究进展

冠心病猝死(sudden coronary death,SCD)是各种猝死中最常见的原因,免疫组织化学技术(immuno-histochemistry,IHC)是近年来研究冠心病猝死的有效方法。本文根据国内外文献对冠心病猝死的法医病理学免疫组织化学研究进展作如下综述。     

车祸致伤后急性肺动脉栓塞猝死2例

在法医实践中猝死的案例时有发生,但在交通事故中因肺动脉栓塞而猝死的案例不多见,特别是在治疗或手术过程中发生猝死常引发医疗纠纷,笔者曾遇2例,现予以报道.     

车祸致伤后急性肺动脉栓塞猝死2例

在法医实践中猝死的案例时有发生,但在交通事故中因肺动脉栓塞而猝死的案例不多见,特别是在治疗或手术过程中发生猝死常引发医疗纠纷,笔者曾遇2例,现予以报道。     

冠心病猝死的病理学研究——附128例尸检分析

本文报道128例冠心病猝死的法医病理学研究结果。其中冠脉病变4级63例,3级26例,2级29例。3级以上病变者斑块分布多较广泛。各支病变中以左前降支最常见。并发新鲜血栓形成者18例,斑块内出血17例,急性心肌梗死仅2例。36例冠脉斑块有炎性细胞浸润。56例见心肌间质纤维化或小灶疤痕形成。指出虽然我国冠心病发病率较低,但仍是猝死最常见的原因,尤以中壮年男性多见;多数病例无明显诱因而于睡眠中猝死。对冠心病猝死发生的特点、冠脉和心肌病变及病理诊断等进行了分析讨论。     

心肌炎猝死案例的法医病理学研究

从法医尸检案例中取心肌炎猝死17例进行分析及病理学观察，对心肌炎的分关、心肌炎导致猝死机制进行探讨，认为诱发急性心力衰竭是心肌炎猝死的主要原因。     

不见血的谋杀

一、女人猝死在家中 到南充市公安局刑警大队担任副队长不久的宗志,一大早就接到春光街派出所电话报警:春光大道一宿舍楼的女主人猝死在家中,望派法医勘验死亡原因。这天是1999年10月18日,星期一。 宗志紧急召集法医杨远、刑警小于、小秦赶赴现场。这是一幢10层高的公寓楼,死者住在5楼。居委会的李大     

心肌炎死亡案例的法医病理学分析

目的探讨心肌炎的猝死机理和法医病理诊断标准。方法对6例心肌炎死亡者进行系统解剖及组织病理学检验;结果6例心肌炎死亡者中,病毒性心肌炎1例,细菌性心肌炎4例,孤立性心肌炎1例。结论急性充血性心衰和心律失常是心肌炎猝死的主要死因。心肌炎猝死的法医病理学诊断:熟悉心肌炎的病理形态特点,结合临床症状及实验室检查,并排除其他死因。     

病毒性心肌炎猝死的法医病理学诊断及猝死机理

通过对典型病毒性心肌炎猝死案例的分析，提出了心肌炎猝死的法医病理学诊断的要点，并对心肌炎猝死的机理进行了讨论。     

IMA和H-FABP在心源性猝死法医学诊断中的应用

急性心肌缺血的发生是心源性猝死的最常见原因,而如何认定早期急性心肌缺血是法医学研究的热点,同时也是临床预防心肌梗死发生的重要环节。本文通过对缺血修饰白蛋白(ischemia modified albumin,IMA)和心型脂肪酸结合蛋白(heart-type fatty acid binding protein,H-FABP)的结构、功能、临床应用价值及法医学中的应用前景进行综述,旨在分析二者是否可作为早期心肌缺血的生化检测指标用于心源性猝死的诊断,并为今后选择心源性猝死的科研方向提供借鉴。     

Impact of Myocardial Infarction and Abnormalities of Cardiac Conduction System on Sudden Cardiac DeathCSCD

Sudden cardiac death (SCD), most commonly seen in coronary heart disease, is a kind of sudden death caused by series of cardiac parameters, which usually combines with myocardial infarction. However, some SCDs (including early myocardial infarction) happen suddenly and cause death in a very short time. In these circumstances, typical morphological changes are lack in macroscopic or microscopic fields, which make such SCDs become the emphasis and difficulty in the present research. SCD caused by myocardial infarction and abnormalities of cardiac conduction system (CCS) is related to atherosclerosis of coronary artery closely. This paper reviews cardiac dysfunction caused by myocardial infarction and diseases of CCS from morphology and molecular biology, and explores potential relationship between them. This paper aims to provide clues to the mechanism of myocardial infarction related sudden death and possible assistance for forensic diagnosis of SCD. © 2017 by the Editorial Department of Journal of Forensic Medicine.     

缺血修饰白蛋白在急性缺血性心脏病中的法医学应用

目的探讨心包液中缺血修饰白蛋白(ischemia modified albumin,IMA)水平在心脏性猝死诊断中的应用价值及法医学意义。方法应用白蛋白-钴离子结合法检测急性缺血性心脏病组(36例)、急性心肌梗死组(6例)、心肌病组(4例)、对照组(15例)死者的心包液中IMA水平,比较各组之间IMA水平的差异。通过ROC曲线获得最佳IMA水平的截断值以及区分急性缺血性心脏病和对照组的敏感度和特异度。结果急性缺血性心脏病组心包液中IMA水平高于对照组(P0.05);而与急性心肌梗死组、心肌病组心包液中IMA水平比较,差异均无统计学意义(P0.05)。应用ROC曲线分析得出识别急性心肌缺血的IMA的截断值为40.65 U/m L,其诊断急性心肌缺血的敏感度为60.0%,特异度为80.5%。结论心包液中IMA有望作为诊断急性心肌缺血的参考指标,为心脏性猝死的法医学诊断提供客观依据。     

心肌缺血猝死心肌中高迁移率族蛋白B-1的表达研究

目的探讨高迁移率族蛋白B-1(High Mobility Group Box protein 1,HMGB1)在心肌缺血猝死后诊断中的法医学价值。方法收集不同案例心肌蜡块分为疑似早期心肌缺血猝死组(早期梗死组)20例、心肌梗死猝死组(心肌梗死组)15例、冠心病非心源性猝死组(对照组1)10例和正常心肌组(对照组2)10例,应用免疫组织化学二步法染色,观察心肌胞核和胞浆中HMGB1表达,用ImagePro Plus 6.0软件计算HMGB1表达的平均光密度,用SPSS 13.0对表达进行数据统计分析。结果 HMGB1在四组心肌细胞胞核中表达均呈阳性;早期梗死组和心肌梗死组胞浆均呈阳性表达,对照组1和对照组2胞浆呈阴性。各组平均光密度分别为0.3031±0.0557、0.3195±0.0523、0.0252±0.0030、0.0207±0.0029,早期梗死组和心肌梗死组的阳性反应与两个对照组相比存在显著差异(P﹤0.01)。结论 HMGB1可作为早期心肌缺血猝死的一个辅助诊断指标。     

Aortic Dissection and Sudden Unexpected Deaths: A Retrospective Study of 31 Forensic Autopsy Cases

Acute aortic dissection (AAD) is the most common cause of sudden unexpected death related to aortic diseases. A retrospective study of 31 sudden unexpected deaths caused by AAD was conducted at Xi'an Jiaotong University Forensic Center from 2001 to 2012. We summarized the forensic characteristics of AAD and assessed the clinically diagnostic accuracy of AAD. The characteristics of sudden unexpected death due to AAD were male predominant (male: female = 6.7:1), relatively young with the mean age of 44, and predominance of type A dissection (77.4%). Cardiac tamponade was the most frequent cause of sudden death (87.1%). Of the 31 cases, 26 (83.9%) patients were not recognized clinically and were misdiagnosed with acute myocardial infarction, coronary artery disease, cholecystitis, acute gastroenteritis, renal/urinary lithiasis, or acute pancreatitis. In summary, AAD can be difficult to recognize, diagnosis is therefore sometimes delayed or missed. The medicolegal death investigation can help physicians have a better understanding of AAD.     

早期心肌缺血猝死心肌NF-κB p65的表达研究

目的探讨核因子NF-κBp65（NF-κB p65）在心肌早期缺血猝死后诊断中的法医学价值。方法将收集的案例心肌蜡块分为3组：正常对照组（3例）、早期心肌缺血组（14例）、心肌梗死组（8例）,采用免疫组织化学技术（SP法）,观察猝死心肌内NF-κBp65的表达情况,并对其结果进行半定量分析。结果早期心肌缺血组和心肌梗死组的心肌细胞胞浆内及细胞核内均出现NF-κBp65的表达,且早期心肌缺血组与心肌梗死组表达强度无差异。结论NF-κBp65可以作为早期心肌缺血猝死的一个辅助诊断指标。     

Relationship of ischemic heart disease to sudden death

A clinicopathological synthesis is presented of the relationship of ischemic heart disease to sudden cardiac death. The immediate pathophysiological process responsible for sudden cardiac death is a lethal arrhythmia, usually ventricular fibrillation. Although significant coronary atherosclerosis is present in most cases of naturally occurring sudden death, available evidence indicates that several mechanisms can be operative in the pathogenesis of the fatal event. These are (1) acute myocardial infarction in a minority of cases; (2) myocardial ischemia, without infarction, which is initiated either by (a) an exertion-induced increase in myocardial oxygen demand or (b) an acute coronary event often involving plaque degeneration and platelet aggregation; and (3) a primary arrhythmia, usually resulting from altered electrical conduction in the setting of a previous myocardial infarction.     

Immunohistochemical study of fibronectin for postmortem diagnosis of early myocardial infarction

The postmortem diagnosis of early myocardial infarction has been a puzzling problem in forensic practice. In the present study, an immunohistochemical study of fibronectin (FN) was performed for the first time on 34 autopsy hearts to determine early myocardial infarction with streptavidin/biotin/peroxidase technique. Five cases of definite myocardial infarction showed positive FN staining of cardiomyocytes; of 18 cases where early myocardial infarction was suspected, positive FN staining of cardiomyocytes was found in 15 cases, but no such staining was seen in 11 non-cardiac death controls. The results led to the conclusion that positive FN staining in cardiomyocytes is a reliable marker of acute myocardial infarction and could be used as a new, sensitive method for the postmortem diagnosis of early myocardial infarction. It is worth noting that all cases in this study were autopsied between 8 h and 4 days after death and 5 cases had been fixed in 10% formalin for over 10 years. FN immunohistochemistry still gave satisfactory results in those cases. It seemed that FN was not affected by postmortem autolysis and formalin-fixation and could be used in routine forensic practice, especially for retrospective analysis of cases.     

大鼠支气管哮喘模型的心肌HSP70表达研究

目的探讨支气管哮喘心肌组织的损害机制,为支气管哮喘诱发的猝死的法医学诊断提供形态学依据。方法应用HE和免疫组化技术,对大鼠支气管哮喘模型的心肌HSP70的表达规律进行研究。结果实验组的心肌HSP70阳性表达明显高于对照组(P<0.01),随着哮喘时间的延续,心肌HSP70的阳性表达逐渐增强(P<0.05),在第8周表达最强。结论实验组支气管哮喘早期心肌有损害,且随时间延续,损害增强。HSP70对支气管哮喘诱发的猝死的法医学诊断有一定的帮助。