| The pathological diagnosis of sudden coronary death (SCD) is one of the important research topics in the field of forensic pathology. For many years, the domestic and foreign scholars have carried a lot of researches from different points on it. The pathological basic of SCD is atherosclerosis (AS) in the coronary artery. As the death occurred rapidly, most of them happened outside the hospital, and no obvious change of pathomorphology was observed by general method of pathology. At present, it was still used to conventional exclusive diagnosis, the golden standard of the SCD diagnosis has not been found. The traditional research attention concentrates much in the early myocardial ischemia and the reperfusion trauma of coronary artery and so on. The blood serum inflammation response markers, such as CRP (C- reactive protein), TL-6 (interleukin-6), TNF (tumor necrosis factor) were found in 70's of last century. It had no doubt of traditional definition of AS, the procession of lipidoses, until that time. In 1999, Ross explicitly proposed the hypothesis of "Atherosclerosis is a kind of inflammation disease", which pointed that AS was not only the procession of lipidoses, but also the procession of the inflammation. Afterwards the massive research revolved in the relationships between the inflammation and AS in coronary artery. Some scholars discovered that CRP level had close relation to the acute coronary artery syndrome. However, there was no report about the expression of CRP in the atherosclerotic plaque. Therefore, the expression changes of CRP in the atherosclerotic plaque of SCD were detected qualitatively and semi-quantitatively by use of immunohistochemiscal and image analysis technology in order to investigate the significant of CRP as a diagnosis marker in the case of SCD, to approach the significance of it as SCD diagnosis.Method: Sixty-eight autopsied cases were selected from the file of our department from year 2001 to 2004. The time from death to autopsy was within 48 hours. All cases were divided into 3 groups of A, B and C. Group A was the cases of SCD. Group B was the cases of coronary heart disease but died of other causes. Group C was a negative group, in which each case had no severe AS in the coronary artery. The standard of case selected was as follows: All of three groups had been removed such factors as the bacterium infection, the viral infection, the anxious or chronic inflammation, the tumor and the immunity disease. The left anterior descending (LAD) and right main (RM) of each case in group A and B had severe atherosclerotic plaque. The degree of stenosis was over 50% in cross section area in LAD and RM of coronary artery, but did not consider the pathological changes of other two branches left main (LM) and left circumflex (LC); the four main branches (LM, LAD, LC and RM) of coronary arteries in the group had no obvious pathological change or only slight stenosis (< 25% in the cross section area of coronary artery) of each case in Group C. Group A had excluded violent death and other diseases, which final diagnosis of SCD, the standard of death time was within 24 hours from onset of symptom to death according to WHO stands. The causes of death in group B and C were violent or other natural diseases (for example, cerebral hemorrhage, intoxication, mechanical asphyxia, mechanical injury and so on). The expressive change of CRP in the atherosclerotic plaque in each case was detected qualitatively and semi-quantitatively by using of immunohistochemiscal staining (SABC method) and the image analysis technology. The statistics analysis was done to the date which was detected.Result:â‘ Group A: Of 27 cases, there were 20 cases in male and 7 in female, with ranging in age from 30 to 74 years old (average 50.30 years). The time from death to autopsy was within 48h. The atherosclerotic plaque in LAD or/ and RM of coronary artery was found in each case, of which 22 cases were narrowed 76% ~100% and 5, 51% ~75%. The heart weighted from 220 to 510g (average 388.22g).â‘¡Group B (CHD non- SCD group, control group I): Of 21 cases, there were 18 cases in male and 3 in female, with ranging in age from 35 to 81 years old (average 52.19 years). The atherosclerotic plaque in LAD or/ and RM of coronary artery were found in each case, of which 8 cases were narrowed 76% ~100% in and 13, 51% ~75%. The hearts weighted from 220 to 495g (average 379.29g). The cause of death: there were 8 cases in traumatic cerebral hemorrhage; 1, mechanical asphyxia; 1, mechanical injury; 4, intoxication; 3, the pathological cerebral hemorrhage; 1, dissection of aorta; 1, brain edema or herniation; 1, fat embolism of lung; 1, cerebral infarction.â‘¢Group C : Of 20 cases, there were 12 in male and 8 in female, with ranging in age from 17 to 42 years old (average 28.70 years). There was no severe AS in coronary artery or only slight stenosis in coronary artery, in which 18 cases were narrow not more than 25%. The hearts weighted from 210 to 350g (average 293.50g). The cause of death: There were 5 cases in cerebral trauma or cerebral hemorrhage; 4, intoxation; 3, mechanical injury; 1, mechanical asphyxia; 1, lighting stroke 1, epileptic attack; 1, fat embolism of lung; 4, amnionic fluid embolism.Immunohistochemiscal dyeing: Twenty-one cases in group A which showed strong positive expression and 6, showed positive expression. Three cases in group B which appeared weak positive expression; 11, very weak positive expression; 7, negative reaction. No positive reaction of CRP was found for each case in group C. The result of statistical analysis indicated that the OD and R values of the CRP expression in the atherosclerotic plaque had significant difference (P <0.01) between group A (SCD group) and group B (control groupâ… ), and also had significant difference (P <0.01) between group A and group C (control groupâ…¡), but no difference between two control groups (group B and group C).Conclusion: The CRP expression is positive in the atherosclerotic plaque. The OD and R values had significant difference between group A and two control groups. The changes of CRP expression in the cases of SCD possibility have some relationship to the occurrence of SCD. The level of CRP expression in atherosclerotic plaque in coronary artery may be considered as a useful marker for the diagnosis of forensic pathology. |
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