【摘要】 目的观察分析云南不明原因聚集性猝死病例心肌炎的病理改变特点,探讨心肌炎在这类猝死中的作用。方法心肌炎的病理诊断参照 Dallas 和世界心脏联合会的标准。分析云南省1991-2006年进行猝死监测期间收集的尸检病例29例,其中14例为心肌炎病例。心肌炎患者年龄8～68岁,平均30岁。男9例、女5例。回顾流行病学资料,核查心脏标本,观察心脏等器官的组织切片,其中3例做了心脏传导系统检查。结果心肌炎共14例,占尸检病例的48%。其中淋巴细胞性心肌炎11例,中性粒细胞性心肌炎3例。心肌炎均表现为局灶性,未见弥漫性心肌炎。仅20%(8%～42%)的心肌组织切片可检出炎性病灶,病灶多分布在左心室侧壁,少数在室间隔和右心室部心肌。病灶区心肌细胞形态损伤多数较轻微,个别病例出现片状心肌溶解或凝固性坏死。多数病变为急性炎,也可见机化和急性损伤共存。4例还伴有心包炎,1例伴亚急性心内膜炎,3例行传导系统检查者中1例炎症波及房室结。心脏外观多无异常,仅2例左室或全心扩大。5例伴有呼吸道和肺部感染。结论心肌炎是云南不明原因聚集性猝死的主要病变之一,病理表现以局灶性为主,病变形态提示病毒和细菌性感染均有可能,但是,尚不能确定心肌炎症与中毒的关系。心肌炎的病因及其与猝死聚集性的关系值得进一步研究。更多还原

【Abstract】 Objectives To study the pathologic feature of sudden cardiac death in Yunnan province and to investigate the role of myocarditis.Methods During the period from 1991 to 2006,there were 29 cases of sudden cardiac death with autopsy performed.Fourteen of these cases were diagnosed to have myocarditis based on Dallas criteria and World Heart Federation’s consensus.The clinical and pathologic findings were reviewed.The cardiac conduction system was examined in details by serial sectioning in 3 cases.Results Fourteen cases suffered with myoearditis,which accounted for 48% of all cases of sudden cardiac death studied.The age of the deceased ranged from 8 to 68 years(mean=30 years),with male-to- female ratio equaled to 9:5.Lymphocytic myocarditis and neutrophil myocarditis were the two major types, affecting 11 and 3 cases,respectively.The inflammatory infiltrates were often patchy rather than diffuse.The inflammatory foci were detected only in 8% to 42%(average=20%)of the paraffin sections of the heart tissue.These lesions were usually located in the lateral wall of left ventricle and occasionally in interventricular septum and right ventricular wall.Myocardial injury was mild in most cases while patchy myocytolysis or coagulation necrosis was observed only in a few cases.Most of the lesions were relatively new and histologic evidence of myocardial repairing sometimes coexisted.Pericarditis and subacute endocarditis were also identified in 4 and 1 cases,respectively.Atrioventricular node was involved by myocarditis in 1 of the 3 cases examined for cardiac conduction system.Two cases showed gross evidence of cardiac dilatation (either left ventricle or biventricular).Respiratory tract and pulmonary infection was present in 5 cases. Conclusions Myocarditis represents one of the major pathologic changes of sudden cardiac death occurring in Yunnan province,The inflammation is usually focal.Further studies are required for delineation of possible etiologies which may include virus,bacteria or exogenous toxin.更多还原