致命室性快速心律失常心室肌能量的代谢改变与氧化损伤

目的探讨致命室性快速型心律失常(LVTA)能量代谢相关变化及氧化损伤。方法建立以乌头碱(ACO)注射和冠脉结扎(CAL)心肌缺血诱导的LVTA-心脏性猝死(SCD)SD大鼠模型,以过度麻醉(PI)及冠脉结扎心衰致死(CAL-B)为各自对照,检测心室肌线粒体膜电位(MMP)、活性氧(ROS)、丙二醛(MDA)、磷酸肌酸(PCr)及血清肌钙蛋白I(cTnI)含量,并进行比较。结果成功制备ACO-LVTA及CAL-LVTA大鼠14只及6只。与各自的同行对照比较,ACO-LVTA组及CAL-LVTA组心室肌的ROS及MDA呈升高的趋势,PCr呈下降的趋势,其中CAL-LTVA的MDA显著高于其同行对照(P0.05)。ACO-LVTA组心室肌的MMP低于对照组,但高于CAL处理的两组。CAL-LVTA组血清cTnI高于对照组,且显著高于ACO-LVTA组及其对照与处理前(P0.01),ACO-LVTA组血清cTnI高于对照组与处理前。心肌ROS水平与VT及VF持续时间相关(P0.05),相关系数分别为0.44、0.46。结论发生LVTA后,心室肌MMP及PCr下降、ROS、MDA升高,血清cTnI升高,表明LVTA可导致能量代谢改变及氧化损伤,可能与线粒体功能异常相关。     

大鼠急性早期心肌梗死细胞膜PNA受体表达

探测急性心肌缺血早期细胞膜PNA受体的表达特点。应用免疫组化法(S-P法)对32只SD大鼠急性心肌缺血早期不同时间心肌细胞膜凝集素受体的表达进行研究。结果发现:心肌缺血15min时,心肌局部可出现PNA染色阳性,且随着缺血时间的延长,其阳性表达面积明显增加;缺血2h;其表达水平达到高峰,呈弥漫性染色阳性,明显高于对照组;2h后,心肌缺血区域PNA受体的表达开始出现下降趋势。实验结果稳定,敏感性强,可为心肌缺血早期诊断提供客观的依据。     

慢性心力衰竭患者血浆脑利钠肽与中医证型及心功能的关系研究

目的 观察慢性心力衰竭（chronic heart failure, CHF）患者血浆脑利钠肽（brain natriuretic peptide, BNP）与中医证型和心功能分级的相关性,为CHF的中医辨证分型提供客观依据。方法 共纳入144例CHF患者,采用纽约心脏病学会心功能分级标准对心功能进行分级,并对患者进行中医辨证分型,采用心脏超声检测左室舒张末期内径（left ventricular end diastolic diameter, LVDd）和左室射血分数（left ventricular ejection fraction, LVEF）,考察血浆BNP水平与中医证型及心功能的相关性。结果 BNP水平与心功能分级（Ⅱ级=2,Ⅲ级=3,Ⅳ级=4）呈正相关（r=0.724,P＜0.01）,与中医证型（心肺气虚证=1,气阴两虚证=2,心肾阳虚证=3,水饮凌心证=4）亦呈正相关 （r=0.813,P＜0.01）。心功能Ⅱ级、Ⅲ级和Ⅳ级之间血浆LVDd、LVEF水平比较,差异均具有统计学意义（P＜0.01）。结论 血浆BNP是反映心功能的敏感且特异的指标,可作为CHF中医辨证分型的客观化指标。     

电针心经对心肌缺血性家兔心力环面积的影响

以心力环面积为指标，静脉滴注垂体后叶素造成家兔心肌缺血动物模型，结果表明，电针心经地心脏功能的调节作用比电针肺经显著，有相对特异性，说明心经作为一条经脉，与心脏机能活动有密切关系。     

Cardiac Ventricular Laceration Due to Child Abuse: Abusive Ventricular Laceration

Traumatic cardiac ventricular ruptures in children are rare. Only a single case of left ventricular rupture due to child abuse has been reported. We report a child who sustained a fatal left ventricular apical rupture. It appeared to have resulted from hydrostatic forces resulting from abusive blunt thoracic injury. That he was being abused was previously missed when he was presented to the emergency department with facial pyoderma. It was not noted that he also had lip and oral mucosal injury, sites not affected by staph toxins. As a result, his underlying, abusive and secondarily infected, facial flow type scald burn was not appreciated. Within a week thereafter his fatal injury occurred, accompanied by extensive and obvious associated abusive injuries. Postmortem high‐detail whole body computed tomography scanning aided the autopsy. Although rare, ventricular rupture from abusive blunt thoracic injury can occur.     

Postmortem Analysis of Electrogram Records from an Implantable Cardioverter‐Defibrillator (ICD) in the Reconstruction of a Road Traffic Accident

The case of a 69‐year‐old man, equipped with an ICD and suffering from several chronic cardiac diseases, who died in a car accident, was presented. We analyzed electrogram records from the ICD explanted from the body during the autopsy, which showed that the driver had suffered from malignant ventricular arrhythmia—ventricular fibrillation (VF). A thorough analysis of the details of the accident, as well as the timing of VF and the rhythm observed after the discharge of the ICD showed that the direct cause of the accident was the episode of arrhythmia resulting in a loss of consciousness. Therefore, the presented case illustrates the usefulness of postmortem analysis of electrogram records from ICDs in the reconstruction of road traffic accidents. In such cases, if the victims are implanted with ICDs, it should be a routine procedure performed by forensic pathologists.     

Multiple Giant Coronary Artery Aneurysms: A Rare Cause of Sudden Cardiac Death

Multiple giant aneurysms involving the coronary arteries are uncommon and rarely reported. In the presented case, a 63‐year‐old man with poorly controlled hypertension died suddenly. Gross autopsy examination showed multiple giant thrombus‐filled coronary artery aneurysms, atherosclerotic coronary artery disease, and cardiomegaly. Histological sections of the coronary aneurysms showed atherosclerotic changes with both organized and fresh thrombus. Giant coronary aneurysm is defined as a segmental enlargement of a coronary artery with a diameter exceeding 20 mm or more. The main etiology of this nebulous entity is attributed to atherosclerosis and inflammatory or inherited connective tissue disorders with the remainder being congenital, infectious, or idiopathic. Before its cataclysmic presentation, when ruptured or thrombosed, giant coronary aneurysm usually has a silent clinical course. Sudden death owing to giant multiple coronary aneurysms is rare and mandates careful classification of the aneurysms and prudent search for autoimmune‐mediated or genetically based factors for subsequent ancillary autopsy studies.     

TGF-β1在SCN5A基因变异所致心源性猝死中调控作用

SCN5A基因变异所致心源性猝死发生机制尚不清楚。目前研究显示TGF-β1介导心肌纤维化以及离子通道重构调节机制的异常可能是SCN5A基因变异导致SUNDS发生的主要原因。本文就转化生长因子β1对SCN5A基因变异所致心源性猝死调控的影响机制研究进展进行综述,以期为心源性猝死法医学研究和实践提供参考。     

窖蛋白与不明原因心源性猝死的相关性研究进展

不明原因心源性猝死(unexpected sudden cardiac death,USCD)因其不伴有心脏结构的异常,尸体解剖呈阴性改变,一直是法医病理学鉴定的热点难题。USCD可能与部分致死性心律失常有关,该类心律失常多由心脏离子通道蛋白或其相关蛋白发生异常所致。窖蛋白可以通过其脚手架区域与多种心肌离子通道蛋白结合,在维持心肌动作电位的去极化和复极化中起到关键作用。当窖蛋白由于基因突变或蛋白表达异常等因素导致其结构和功能受到影响时,受其调控的心肌离子通道的功能也受到损害,继而引起多种离子通道病的发生,出现心律失常甚至心源性猝死。研究窖蛋白对离子通道功能的影响对于探索恶性心律失常及心源性猝死的发生机制具有重要意义。     

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。