非正常死亡3例克山病的尸检分析(1)
摘要：克山病是一种原因不明以心肌损伤为主的地方性心肌病。在我国流行于东北、内蒙、西北、四川等13个省区。东北和西北地区多在冬季发病，而西南地区多在夏季发病。男女老幼均可发病，但以小儿及青年妇女多见。按心功能状态分为四型：1.急性型，起病急，多伴有心源性休克及严重的心律紊乱，可发生猝死。2.亚急性型，既有心源性休克又有充血性心力衰竭。3.慢性型，又称痨型，以充血性心力衰竭为主。不少病人由于心脏增大而充分发挥代偿作用，所以在心衰出现之前症状多不明显，但可因突然增加心脏负担而发生猝死。前三例死者生前平素无明显症状，能坚持日常工作和生活，系在情绪激动、跑步、打架和劳动等情况下发生突然死亡。4.潜在型，心脏不同程度增大。心功能代谢较好，故无明显自觉症状。可发生于貌似健康的人，亦可为其他型好转的结果。
关键词：非正常死亡；克山病；法医病理学；鉴定分析
Abstract:The Keshan disease is a cause of unexplained to myocardial injury endemic cardiomyopathy. Popular in China in the northeast, northwest, Inner Mongolia, Sichuan and other 13provinces. The northeast and northwest regions in winter onset, and the southwestern region in summer disease. Men and women, old and young onset can be, but to children and young women. According to heart function was divided into four types:1acute, rapid onset, often accompanied with cardiogenic shock and severe cardiac arrhythmias, sudden death. 2 subacute type, both cardiogenic shock, congestive heart failure. In 3 chronic type, also known as tuberculosis, to congestive heart failure mainly. Many patients with cardiac enlargement and fully play a compensatory role, so in the heart failure before the appearance of symptoms is not clear, but may be due to the abrupt increase heart burden and the occurrence of sudden cardiac death. In three patients before the deceased had no obvious symptoms, can adhere to the daily work and life, in the emotional, running, fighting and labor occurs in cases of sudden death. 4potential type, different heart rate increase. Heart function metabolism is better, there is no obvious symptoms. Can occur in apparently healthy people, can also be used for other type of better results.
, http://www.100md.com
Key words:unnatural death; Keshan disease; forensic pathology; identification and analysis
【中图分类号】R542.3 【文献标识码】B 【文章编号】1674-7526(2012)04-0011-02
克山病是一种地区流行的原发性心肌病，于1935年在黑龙江省克山县首先发现[1]。甘肃省泾川县是我国西北克山病的流行病区，自改革开放后，本病发病率明显降低，目前未发现有新发病例。自1985年以来我们在工作中对非正常死亡案例中有3起克山病死亡案例归纳成篇，报道如下。
1 案例资料
案例1 某女，27岁，农民。1985年7月4日晚饭后与丈夫发生口角后，突然感到头晕，四肢无力，并出现呕吐，皮肤苍白，出冷汗，四肢冰凉等症状，症状仍继续加重，3小时候死亡。疑中毒致死。尸检见心脏增大近球型，重395g，左、右心室扩张，心肌质软而松弛，切面有土黄色片状病灶。光镜下，心肌变性及坏死，并有部分坏死的肌纤维溶解而形成肌膜空架。毒物分析未检出常见毒物。鉴定意见为急性克山病致心源性休克死亡。
, 百拇医药
案例2 某女， 33岁，农民。于1996年12月1日与邻居因邻里间纠纷发生争吵，并相互厮打在一起，后被他人解劝开后，回家后休息，次日清晨被发现已死亡，家属报案系邻居打伤后死亡。尸检见颜面部有几处抓伤造成皮肤擦伤外，其余全身未见致命性外伤。尸检见心脏明显增大，重430g，左、右心室扩张，左心室较右心室明显。心壁未见增厚，切面有散在性小灶状病灶。光镜下，心肌变性及坏死，并有部分坏死的肌纤维溶解，增生纤维形成瘢痕组织。毒物分析未检出常见毒物。鉴定意见为死者生前患有慢性克山病，在情绪激动情况下心脏负担增加致急性心力衰竭而死亡[2]。
案例3 某男，39岁，干部。2003年7月2日，在一场篮球比赛中，因故与裁判发生殴斗。突然倒地死亡。尸检全身未发现致命性外伤。心脏明显增大，重466g。左心室较右心室明显扩张，左心室内有血栓附着，心肌切面有散在的灰黄色斑状瘢痕。镜下心肌呈散在大块消失，被瘢痕组织代替。经调查死者出生地为克山病流行病区，生长至少年期。据此鉴定意见为，死者系在原患慢性克山病(痨型克山病的)的基础上，由于情绪激动和剧烈体力活动，心脏负担突然增加致急性心力衰竭而猝死[2]。, 百拇医药(韩锴)
关键词：非正常死亡；克山病；法医病理学；鉴定分析
Abstract:The Keshan disease is a cause of unexplained to myocardial injury endemic cardiomyopathy. Popular in China in the northeast, northwest, Inner Mongolia, Sichuan and other 13provinces. The northeast and northwest regions in winter onset, and the southwestern region in summer disease. Men and women, old and young onset can be, but to children and young women. According to heart function was divided into four types:1acute, rapid onset, often accompanied with cardiogenic shock and severe cardiac arrhythmias, sudden death. 2 subacute type, both cardiogenic shock, congestive heart failure. In 3 chronic type, also known as tuberculosis, to congestive heart failure mainly. Many patients with cardiac enlargement and fully play a compensatory role, so in the heart failure before the appearance of symptoms is not clear, but may be due to the abrupt increase heart burden and the occurrence of sudden cardiac death. In three patients before the deceased had no obvious symptoms, can adhere to the daily work and life, in the emotional, running, fighting and labor occurs in cases of sudden death. 4potential type, different heart rate increase. Heart function metabolism is better, there is no obvious symptoms. Can occur in apparently healthy people, can also be used for other type of better results.
, http://www.100md.com
Key words:unnatural death; Keshan disease; forensic pathology; identification and analysis
【中图分类号】R542.3 【文献标识码】B 【文章编号】1674-7526(2012)04-0011-02
克山病是一种地区流行的原发性心肌病，于1935年在黑龙江省克山县首先发现[1]。甘肃省泾川县是我国西北克山病的流行病区，自改革开放后，本病发病率明显降低，目前未发现有新发病例。自1985年以来我们在工作中对非正常死亡案例中有3起克山病死亡案例归纳成篇，报道如下。
1 案例资料
案例1 某女，27岁，农民。1985年7月4日晚饭后与丈夫发生口角后，突然感到头晕，四肢无力，并出现呕吐，皮肤苍白，出冷汗，四肢冰凉等症状，症状仍继续加重，3小时候死亡。疑中毒致死。尸检见心脏增大近球型，重395g，左、右心室扩张，心肌质软而松弛，切面有土黄色片状病灶。光镜下，心肌变性及坏死，并有部分坏死的肌纤维溶解而形成肌膜空架。毒物分析未检出常见毒物。鉴定意见为急性克山病致心源性休克死亡。
, 百拇医药
案例2 某女， 33岁，农民。于1996年12月1日与邻居因邻里间纠纷发生争吵，并相互厮打在一起，后被他人解劝开后，回家后休息，次日清晨被发现已死亡，家属报案系邻居打伤后死亡。尸检见颜面部有几处抓伤造成皮肤擦伤外，其余全身未见致命性外伤。尸检见心脏明显增大，重430g，左、右心室扩张，左心室较右心室明显。心壁未见增厚，切面有散在性小灶状病灶。光镜下，心肌变性及坏死，并有部分坏死的肌纤维溶解，增生纤维形成瘢痕组织。毒物分析未检出常见毒物。鉴定意见为死者生前患有慢性克山病，在情绪激动情况下心脏负担增加致急性心力衰竭而死亡[2]。
案例3 某男，39岁，干部。2003年7月2日，在一场篮球比赛中，因故与裁判发生殴斗。突然倒地死亡。尸检全身未发现致命性外伤。心脏明显增大，重466g。左心室较右心室明显扩张，左心室内有血栓附着，心肌切面有散在的灰黄色斑状瘢痕。镜下心肌呈散在大块消失，被瘢痕组织代替。经调查死者出生地为克山病流行病区，生长至少年期。据此鉴定意见为，死者系在原患慢性克山病(痨型克山病的)的基础上，由于情绪激动和剧烈体力活动，心脏负担突然增加致急性心力衰竭而猝死[2]。, 百拇医药(韩锴)