| Background: The detection of SCD has been one of the most important work of forensic and pathological medicine. Myocardial ischemia is often regarded as the main trigger which leads to SCD. But neither through nake examination nor with normal histological techology (H&E stain), focus of myocardial infraction could be detected so seldom that to seek useful markers, which can show early myocardial ischemia, has been a very important and difficult problem in studies of SCD. However, other significance aspects frequently been ignored, that is factors besides myocardial ischemia leading to SCD and mechanisms of SCD. ANP and BNP, one of natriuretic peptide respectively, are neuroendocrine hormone of heart, which have a lot of physiological functions including regulating blood volume, electrolytes and blood vessel. It have been found that level of blood plasma concentration of the two could reflect the function of heart and had a good correlation with all the possible reasons of SCD including ischemic and non-ischemic factors. Objective: Through to detect expression of ANP and BNP in human myocardium from forensic autopsy divided into SCD, non-SCD and non-SD Groups, we want to study the distribution of them in myocardium of SCD, and further explore the mechanism leading to SCD under ischemic or non-ischemic factors and their values of diagnosis of SCD. Methods: 36 hearts of autopsy are selected from forensic department performed between 2000 and 2004, in which the male was 21, the female was 15, whose mean age was 44.9 years. They were divided into three Groups according to the below standards: (1) SCD Group(Group A) had 12 cases that comprise 4 coronary arteriosclerotic heart diseases without focus of myocardial infarction, 4 cardiomyopathies and 4 myocarditis. All of the cases were diagnosed by macroscopic and microscopic examination, and no pathological changes in other systems could be detected. (2) non-SCD Group (Group B) had 12 cases including 4 cerebral hemorrhages, 4 pulmonary embolisms, 4 acute peritonitis. It had been determined that their were not any other diseases found in the myocardiums of the cases. The victims in Group A and B normally seemed to be healthy and all lost their lifes in 24 hours after a sudden beat. (3) non-SD with normal myocardium Group, the cases had suffered from diseases of several systems other than heart, and the time from occurrence of symptom to death was at least 48 hours. Pathological changes in myocardiums also could not been detected. Myocardium tissue were cut from right atrium and left ventricle anterior wall respectively and paraffin embedded and sectioned. Sections were stained for ANP and BNP and also with H&E. H&E stain and expression of ANP and BNP in each section were detected under microscope, and degrees of immunohistochemical expression according to the standard determined before, were send to SPSS 11.0 for statistical analysis. Results: 1 There were not definite focus detected in coronary artery disease cases of SCD group using H&E stain. Pathological diagnosis of myocarditis and myocardiopathy was definite. Visible pathological changes could not be detected in non-SCD and non-SD with normal myocardium groups. 2 In SCD Group, Extensive expression of ANP and BNP in right atrium could been seen, of which There were severe positive stain in cardiac muscle fiber and endocardium, secondary in blood vessel endothelium and smooth muscle, weakly in tunica adventitia and negative expression in interstitium. Visible positive stains were detected in endocardium, myocardium under endocardium, blood vessel endothelium and smooth muscle of left ventricular muscle sections, in which weaklypositive stain in cardiac muscle fibers and negative stain in tunica adventitia and interstitium had been showed. The differences of expressive distribution and intension of natriuretic peptide among coronary artery disease, myocarditis and myocardiopathy were not significant. There was only 1 case whose expression of ANP was negative. 3 In non-SCD and non-SD with normal myocardium Groups, the...
|
PDF Full Text Request