心脏淀粉样蛋白沉积与法医尸检--回顾与分析

IF 1.2 4区 医学 Q3 MEDICINE, LEGAL
Luzern Tan , Roger W. Byard
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引用次数: 0

摘要

虽然心脏中的淀粉样物质在尸检中并不少见,但有时可能难以确定其对死亡的终极机制可能产生的影响。我们对文献和南澳大利亚法医科学院 20 年(2003-2022 年)内的尸检案例进行了审查,以了解所有在心脏显微镜检查中发现大量淀粉样物质的案例。结果发现了 16 个病例,其中 11 个病例的致死原因与心脏淀粉样蛋白有关,5 个病例的致死原因被认为是偶然特征。在这11个致死病例中,有3个病例的死因是心脏淀粉样变性,8个病例的死因是心脏淀粉样变性以及缺血性心脏病(7例)和支气管肺炎(1例)。患者年龄在 47-92 岁之间,平均 78.6 岁,男女比例为 10:1。心脏重量从496克到1059克不等,平均为648克。在5例偶然发现的病例中,死亡原因分别为头部钝伤(2例)、小肠缺血(2例)和小肠梗阻(1例)。法医病例中最常见的淀粉样变性类型是轻链淀粉样变性、老年性心脏淀粉样变性和家族性淀粉样变性心肌病。影响心脏的其他形式的淀粉样变性,包括反应性淀粉样变性、血液透析相关淀粉样变性和孤立性心房淀粉样变性,要么临床意义很小或没有临床意义,要么意义不确定。虽然尸检时很难确定淀粉样物质对预后的影响,但临床病理相关性可提供有用的辅助信息。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Cardiac amyloid deposition and the forensic autopsy – A review and analysis

Although amyloid material in the heart is not infrequently encountered at autopsy it may on occasion be difficult to determine the significance in terms of possible contributions to the terminal mechanisms of death. A review was undertaken of the literature and of autopsy cases at Forensic Science SA over a 20-year-period (2003–2022) for all cases where significant amyloid material had been encountered on microscopy of the heart. Sixteen cases were found consisting of 11 cases where cardiac amyloid was involved in the lethal episode, and five where it was considered an incidental feature. Of the 11 lethal cases, there were three where cardiac amyloidosis was the cause of death, and eight where it was a contributing factor, along with ischaemic heart disease (N = 7) and bronchopneumonia (N = 1). The age range was 47–92 years, average 78.6 years, with a male to female ratio of 10:1. The weights of the hearts ranged from 496 to 1059 g - average 648 g. Of the five cases where it was considered an incidental finding, the causes of death were blunt head trauma (N = 2), small intestinal ischaemia (N = 2) and small intestinal obstruction (N = 1). The weights of the hearts ranged from 299 to 487 g, average 369 g. The most relevant types of amyloidosis in forensic cases tend to be light chain amyloidosis, senile cardiac amyloidosis and familial amyloid cardiomyopathy. Other forms of amyloidosis that affect the heart, which include reactive amyloidosis, haemodialysis-related amyloidosis and isolated atrial amyloidosis, either have minimal or no clinical significance, or are of uncertain significance. While it may be difficult to determine the prognostic significance of amyloid material at autopsy clinicopathological correlation may provide useful supportive information.

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来源期刊
CiteScore
2.70
自引率
6.70%
发文量
106
审稿时长
57 days
期刊介绍: The Journal of Forensic and Legal Medicine publishes topical articles on aspects of forensic and legal medicine. Specifically the Journal supports research that explores the medical principles of care and forensic assessment of individuals, whether adult or child, in contact with the judicial system. It is a fully peer-review hybrid journal with a broad international perspective. The Journal accepts submissions of original research, review articles, and pertinent case studies, editorials, and commentaries in relevant areas of Forensic and Legal Medicine, Context of Practice, and Education and Training. The Journal adheres to strict publication ethical guidelines, and actively supports a culture of inclusive and representative publication.
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