冠心病猝死冠状动脉粥样硬化斑块病理形态学观察

目的观察冠心病猝死(SCD)和对照组心冠状动脉(CA)粥样硬化斑块的差异,探讨其在SCD中的意义。方法从本教研室2001年~2003年尸检档案中挑选64例有严重CA粥样硬化病变的病例及心脏标本,分SCD组(36例)和对照组(28例冠心病非猝死者)。除常规检查心脏外,重点检查CA左主干(LM)、左前降支(LAD)、左旋支(LC)和右主支(RM)的开口、类型、走向及粥样硬化斑块情况。每支CA分近、中、远3段,检测每个斑块距开口的距离、狭窄程度、长度、数目和形状(分偏心、环形、偏心+环形三种)。用SPSS11.5统计软件进行统计分析。结果SCD组中CA粥样硬化病变4级21例,3级15例;对照组4级12例,3级16例。两组斑块病变的严重程度无显著性差异(P>0.05)。SCD组粥样斑块长(x-2.0365 cm)、以CA近段较多、与CA开口或分支处的距离近(x-0.7457 cm);对照组斑块短(x-1.4283 cm)、以中段多见,与CA开口或分叉处的距离远(x-2.1942 cm);两组斑块的长度和距开口的距离均有非常显著性差异(P<0.01)。两组间斑块的形状在LAD和RM有显著性差异(P<0.05),而LM和LC则无(P>0.05)。结论SCD与冠心病非猝死者的CA粥样硬化斑块在部位、长度、形状和距CA开口的距离存在差异,而狭窄程度无差异。这对SCD的病理诊断和法医学鉴定具有十分重要的意义。

Pathological morphological study of coronary atherosclerotic plaques in cases of sudden coronary death

Objective To investigate the differences of atherosclerotic plaques in coronary artery(CA) between the cases of sudden coronary death(SCD) and control group and to probe the significance in the diagnosis of SCD.Methods All 64 autopsied cases and heart samples were selected from the files of our department from 2001 to 2003,which were classified into 2 groups,SCD(36 cases) and control group(28 cases,violent death or nonviolent death except SCD).The heart were examined in routine pathological method, especially in the opening,type and atherosclerotic plaque of CA,which included 4 major branches of CA(left main,LM;left anterior descending,LAD;left circumflex,LC;right main,RM).Each branch of CA was divided into 3 segments(proximal,middle and distal) and was carefully detected to the distance from the plaque to opening of CA,degree of stenosis,length,site and amount and form of atherosclerotic plaque of CA.The degree of stenosis was divided into 4 degrees(I,II,III and IV) according to the percentage in cross-sectional area of CA,and the form of plaque was categorized into 3 kinds(partial,annular and partial + annular).The detected data were analyzed with the software of SPSS11.5.Results There were 21 cases in IV degree and 15 in III of luminal stenosis of CA in 36 cases of SCD and 12 in IV and 16 in III in 28 cases of control group.The difference of degree of stenosis between two groups had not significance(P>0.05).The atherosclerotic plaques of CA in the cases of SCD were longer(2.036cm),common in the proximal segments,closer to the opening(0.7457cm),but they were shorter(1.4283cm),common in the middle segments,farther from the opening(2.1492cm in the distance from the opening) in the control group.The plaques length and distance from opening of CA between 2 groups had very significant difference(P<0.01).The form of plaque had significant difference(P<0.05) in LAD and RM of CA between 2 groups,but had not in LM and LC(P>0.05).Conclusion The atherosclerosis plaques of CA between SCD and contrast group have significant differences in the sites,length,form and the distance from opening of CA,but has not difference in the degree of stenosis.It is of very important significance to the pathological diagnosis and medicolegal expertise of SCD.