类胰蛋白酶和IgE测定在过敏性猝死诊断中的应用研究

目的探讨过敏性猝死法医学鉴定的诊断方法和指标。方法采取10例正常人、9例过敏性猝死和19例其他死因（排除过敏反应、冠心病）尸体的静脉血，采用荧光酶联免疫法（Pharmacia UniCAP100过敏原定量分析仪）和酶联免疫吸附试验ELISA法分别测定血清肥大细胞类胰蛋白酶和]gE含量，采用免疫组化方法观察过敏性猝死和其他死因的肺组织中的肥大细胞类胰蛋白酶免疫组化染色。结果过敏性猝死者的血清类胰蛋白酶和IgE含量升高，与其他死因之间的差异具有显著性意义（P〈0．01），其他死因和正常人之间的差异无统计学意义（P〉0．05）；与其它死因相比，过敏性猝死肺组织中的肥大细胞类胰蛋白酶免疫组化阳性染色增强（P〈0．01）。结论过敏性猝死者血清IgE和肥大细胞类胰蛋白酶含量显著升高；过敏性猝死者肺组织中肥大细胞类胰蛋白酶染色增强。     

过敏性和冠心病猝死者心肌组织中肥大细胞类胰蛋白酶、脑利钠肽的表达

目的探讨肥大细胞类胰蛋白酶、脑利钠肽(brain natriuretic peptide,BNP)在过敏性猝死和冠心病猝死鉴别诊断中的意义。方法选取山西医科大学法医病理学教研室2010—2015年尸检案例心肌标本共30例,分为颅脑损伤致死组、过敏性猝死组、冠心病猝死组,每组各10例。采用免疫荧光染色和Western印迹法分析各组心肌组织肥大细胞类胰蛋白酶和BNP的表达。结果过敏性猝死组、冠心病猝死组心肌组织内肥大细胞类胰蛋白酶免疫荧光染色均出现阳性染色;三组间两两比较,表达差异均具有统计学意义(P0.05)。冠心病猝死组心肌组织内BNP的表达量高于过敏性猝死组、颅脑损伤致死组(P0.05),过敏性猝死组与颅脑损伤致死组之间差异无统计学意义(P0.05)。结论联合检测心肌组织内肥大细胞类胰蛋白酶、BNP有望为过敏性猝死和冠心病猝死的法医学鉴别诊断提供帮助。     

过敏性休克死亡者肺组织类胰蛋白酶及类糜蛋白酶的表达

目的观察类胰蛋白酶与类糜蛋白酶在过敏性休克死亡人体肺组织中的表达,并探讨其在过敏性休克死亡法医学鉴定中的意义。方法应用荧光免疫组化法对类胰蛋白酶与类糜蛋白酶进行检测,同时以10例CO中毒死者为对照：采用图像分析仪及Image—pro plus 5．0．2软件进行图像分析,计算阳性肥大细胞数及类胰蛋白酶、类糜蛋白酶荧光表达强度。结果与对照组相比,实验组肺组织中类胰蛋白酶和类糜蛋白酶表达差异有统计学意义（P〈0．05）。结论过敏性休克死亡人体肺组织中类胰蛋白酶与类糜蛋白酶的表达增强．可作为过敏性休克死亡的形态学诊断依据。     

IgE升高非过敏性猝死1例

1案例资料 1.1 简要案情 某男,73岁.某日因身体不适、呼吸不畅到某私人诊所就诊,给予静脉输入乳酸红霉素(0.5g)、地塞米松(20mg)及氯化钠注射液(250mL)治疗,输液过程中家人发现其呼吸急促、呼之不应,后"120"送至医院经抢救无效死亡. 1.2尸体检验 死后4d进行尸体检验.尸表除右肘窝可见针眼,其周围皮肤青紫,余体表未见损伤.解剖检验见心脏与心包广泛粘连,心脏表面可见大面积陈旧性梗死灶,余未见异常.     

大鼠过敏性休克死后血清IgE、类胰蛋白酶的变化

目的观察大鼠过敏性休克死亡后血清IgE、类胰蛋白酶的变化规律,探讨其与死亡时间(PMI)、尸体及样本保存环境的相关性。方法建立大鼠过敏性休克死亡动物模型并分组,包括室温组、冷藏组、冷冻组、人工溶血组、血清样本保存组,并设立对照组。大鼠处死采血后,按离心后上层血清颜色进行溶血程度分级。通过ELISA法检测血清IgE、类胰蛋白酶在各组中的质量浓度。结果大鼠过敏性休克死亡后血清IgE、类胰蛋白酶水平明显高于对照组;室温、冷冻保存下血清IgE、类胰蛋白酶随PMI的不同有明显变化,冷藏保存下浓度相对稳定;随溶血程度的增加,血清IgE、类胰蛋白酶水平均呈升高趋势。样本不同温度条件下保存25 d,血清IgE、类胰蛋白酶无明显变化。结论大鼠过敏性休克死后血清IgE、类胰蛋白酶明显升高,但其水平受PMI、环境温度影响较大,尤其是室温或冷冻保存。     

实验性兔羊水栓塞肥大细胞类胰蛋白酶的含量变化

目的观察家兔羊水栓塞 (AFE)后肺组织中肥大细胞类胰蛋白酶 (MCT)含量的变化。方法分别于健康怀孕家兔耳缘静脉注入羊水、制造羊水栓塞的动物模型 ;取肺组织进行HE染色和免疫组织化学MCT染色 ,镜下观察AFE兔肺组织中MCT的变化。结果对照组兔肺组织MCT呈弱阳性反应 (平均阳性细胞计数 11 2 5个 ) ,注入羊水组和注入胎盘提取液与羊水混合液组肺组织中MCT呈强阳性反应 (平均阳性细胞计数分别为 3 2 98和 45 5 3个 )。结论在羊水栓塞时兔肺组织MCT含量增加     

过敏性猝死者咽喉和胃肠组织内P物质的表达

目的观察P物质在过敏性猝死人体咽喉和胃肠组织的表达,并探讨其在法医学鉴定中的作用和意义。方法应用免疫组化方法对15例过敏性猝死者咽喉和胃肠组织的P物质表达进行研究,同时以冠心病猝死者作为对照;应用计算机图像分析系统对免疫组化染色结果进行分析,计算阳性指数(PI)。结果与对照组相比,实验组咽喉和胃肠组织P物质表达明显增加(P<0.001)。结论咽喉和胃肠组织的P物质表达可作为过敏性猝死的法医学鉴定的形态学依据和参考指标。     

服用中药方剂致过敏性猝死1例

中药方剂是多味中药混合熬制而成,是一些慢性病、中老年病人的常用药。一般中药方剂毒副作用小,较少发生过敏反应及过敏性休克死亡。本文报道1例服用中药方剂致过敏性休克死亡,并对其鉴定要点进行了分析、讨论,旨在引起对该诊断的重视。1案例某女,22岁。2005年5月18日生一女孩后,26日早6时许说“头痛、发烧”。其丈夫遂到一中医诊所,开了2付中药方剂(麻黄、细辛各10g,防风、荆芥、黄连各12g,杏仁、白芷、二活、蒿本、京子、枝子、黄芩、香附、郁金、天麻各15g、瓜蒌20g,二花、川芎各25g)回家熬好给该女口服。服后30m in,该女四肢抽搐,脸色发…     

肥大细胞类胰蛋白酶的免疫组化染色观察

目的　观察过敏性休克死亡者咽喉、肺、小肠组织肥大细胞类胰蛋白酶 (MCT) ,探讨过敏性休克死亡法医鉴定的形态学依据。方法　交通事故致严重颅脑损伤死亡者 10例 (对照组 )、明确诊断为过敏性休克死亡者 15例(实验A组 )和羊水栓塞死亡者 8例 (实验B组 )的尸体 ,分别取其咽喉部、肺及小肠组织 ,石蜡切片 ,HE染色及用免疫组化超敏SP法进行MCT染色。结果　实验A组的咽喉部组织充血、水肿 ,咽喉部粘膜下层MCT增多 (MCT颗粒计数为 48 2 3 ) ;实验B组的咽喉部粘膜下层MCT增多 (MCT颗粒计数为 42 72 )。肺间质尤其是小支气管壁及小血管壁上MCT增多 (MCT颗粒计数分别为 46 98和 43 5 0 ) ,小肠粘膜层MCT增多 (MCT颗粒计数分别为 48 2 3和 42 72 )。对照组的咽喉部、肺和小肠MCT颗粒计数较少 ,分别为 7 79、 12 94和 2 0 2 5。实验A组与对照组相比 ,两组具有显著性差异 (P <0 0 1) ;实验A、B组相比 ,两组无显著性差异 (P >0 0 1)。结论　过敏性休克及羊水栓塞死亡的尸体 ,其咽喉部组织、肺组织及胃肠道组织MCT增多。     

类胰蛋白酶在过敏性休克死者心肺肠组织中的表达

目的观察过敏性休克死亡者心、肺及空肠组织中类胰蛋白酶免疫荧光表达的强度,为过敏性休克死亡提供法医学鉴定依据。方法运用免疫荧光染色法对过敏性休克死亡者心、肺及空肠组织进行类胰蛋白酶染色,荧光显微镜观察并采集图像,Image-pro plus6.2软件进行图像分析并计算阳性颗粒数,运用SPSS17.0软件进行统计学分析。结果过敏性休克死亡者心、肺及空肠组织中类胰蛋白酶的表达均明显高于对照组(P0.05),其差异具有统计学意义。结论当高度怀疑过敏性休克但无法获得满意的血液标本时,检测其心、肺及空肠组织中类胰蛋白酶的免疫表达可作为过敏性休克死亡法医学鉴定的辅助手段。     

过敏性休克死亡法医学诊断的研究现状

过敏性休克死亡在临床医学及法医学鉴定中较为常见,但过敏性猝死的死后诊断一直是法医病理学鉴定的一大难点。近年来,国内外学者研究了过敏性死亡血清IgE、组胺、肥大细胞类胰蛋白酶和P物质的含量以及其在肺脏和胃肠等组织中的免疫表达,试图为过敏性猝死的法医学鉴定提供客观、准确的形态学依据和诊断指标。本文就过敏性休克死亡法医学诊断的研究进展和存在的问题加以综述。     

Common mitochondrial DNA deletion associated with sudden natural death in adults

One of the most frequent causes of death in developed countries is sudden natural death (SND), which is the most common indication for medico-legal autopsies. Cardiac diseases are frequently detected among SND. Mitochondrial DNA (mtDNA) is easily damaged by reactive oxygen species, and it may cause dysfunction in tissues, leading to early events in cardiovascular disease. A specific mtDNA deletion of 4977 bp is associated to aging, myocardial dysfunction, and bioenergetic deficit. The potential link between mtDNA damage and SND has not been investigated before. Our aim was to evaluate the accumulation of the common mtDNA4977-deletion in cardiac muscle samples from autopsies of SND in adults (n = 14) in comparison to control samples from unnatural deaths (n = 12). Serial dilution-polymerase chain reaction method was performed to estimate the proportion of the total mtDNA harboring the mtDNA4977-deletion. Coefficient variation intra-assay was 8%, and inter-assay was 12%. MtDNA4977-deletion percentage was higher in samples obtained from victims of SND than in those from subjects who died of unnatural causes (p < 0.05). No differences in mtDNA4977-deletion were found between SND victims 39-51 years old, and no correlation was found between these samples and age, r = 0.30, p = 0.29 while it was significant among control samples, r = 0.68, p < 0.05. The association between mtDNA4977 deletion with SND victims might offer a tool to provide additional information to clarify complex SND investigations.     

血清IgE在药物过敏性休克死亡鉴定中的价值

目的 探讨血清IgE在药物过敏性休克死亡鉴定中的应用价值。方法 采用MEIA法，对17例明确鉴定为药物过敏性休克死亡者(休克组)和16例交通事故死亡者(对照组)的心血进行IgE检测，并对2组IgE检测结果进行统计学分析。结果 休克组IgE水平为(622.49±594.67)U／ml，对照组为(45.04±43.62)U／ml；经t检验，2组显著差异(P＜0.01)。结论 血清IgE水平升高，可作为鉴定药物过敏性休克死亡的依据之一。     

Mitral valve prolapse syndrome as cause of sudden death in young adults

Mitral valve prolapse syndrome (MVPS) is a relatively common disorder of the mitral valve and most cases take a benign clinical course. Only a subset of patients develop severe clinical symptoms such as arrhythmia, insufficiency of the mitral valve or infective endocarditis. As a consequence, sudden death might occur in these patients, thought to be caused by an arrhythmogenic event. By presenting six cases of sudden unexpected death in young female adults, we point at clinical and pathological data from the literature, which are of interest from the viewpoint of legal medicine. The incidence of MVPS in autopsy series has been reported to be about 4-5%, while clinical data hint at an incidence of about 2.5%. The presented cases suggest that even clinically benign cases of MVPS in young adults might result in sudden unexpected death. Such cases are not included in hospital based studies on the topic. This might lead to an underestimation of the fatal risk associated with the disease, even if sudden death might be a rare event in MVPS.     

Pathologico-anatomic findings in sudden, unexpected death in children and adults with influenza A infection

Thé following observations resulted from studies on forensic autopsy cases: In 76% of the adults and 55% of the infants the cases of unexpected sudden death without morphologically verifiable causes of death showed virologic evidence of recent influenza-A (H3N2)-infection. The pathologic findings corresponded with the findings in lethal infections with influenza-A viruses. Investigation of cases of sudden and unexpected death should always include virologic serum tests. The demonstration of IgM antibodies against influenza-A virus confirms that there was a recent infection. Death from influenza-A infections occurs also in the interepidemic periods.     

Tuberculosis and sudden death in Baghdad

Tuberculosis deaths represent a recognizable proportion of all medicolegal statistics in and around Baghdad. Out of the total number of autopsies performed at the Medicolegal Institute at Baghdad, Iraq, in the years, 1948, 1953, 1958, 1963, 1968, 1973, and 1978, 168 sudden deaths were attributed to tuberculosis. Bilateral pulmonary tuberculosis was the principle lesion in the majority of the victims. Tuberculosis cavitation was the major finding in 126 cases, followed by advanced pulmonary TB without cavitation in 25. There was no gross abnormality, except for a histological basis of pulmonary TB associated with miliary TB involving hepatic, renal, meningeal, and mesenteric organs in the remaining 17 autopsies. The abrupt and suspicious deaths in older people, especially during cold months, is more likely due to TB. Autopsy should be performed in all cases of sudden and suspicious deaths. Histological study of different body organs, whether death is attributed by the investigative authority or not related to TB, should be required in all medicolegal autopsies, in order to obtain a true picture of TB as a natural cause of death.