106例心脏性猝死的病理和相关因素分析

目的探讨心脏性猝死(SCD)的病理基础及相关因素,为SCD的诊断和防治提供线索。方法回顾性分析我院106例SCD的临床病理资料,分析SCD的病因及年龄,SCD的诱因,各种导致SCD病因的病理改变。结果106例SCD中,冠心病49例,心肌炎15例,心肌病20例,主动脉夹层动脉瘤破裂7例,先天畸形6例,克山病2例,心肌萎缩1例,心脏轻微病变6例。106例SCD中85例具有诱因。冠心病是中老年人SCD的最主要原因。冠心病SCD49例中,冠状动脉粥样硬化血管Ⅳ级狭窄40例,27例呈多支Ⅳ级狭窄;发生急性心肌梗死(简称心梗)10例,其中2例合并陈旧性心梗,单纯陈旧性心梗21例,18例无心梗,仅有心肌缺血。心肌炎和心肌病是中、青年人SCD的主要病因。有6例心脏无明显器质性改变,称之为阴性解剖或青壮年不明原因猝死。结论尽早防治冠心病、监测粥样硬化斑块成分、改善心肌供血是预防中老年SCD的根本措施,减少不良刺激和情感应激对预防SCD有一定意义。在解剖阴性者中进行分子基因筛查,对解释病因和SCD危险分层有重要作用。

Pathological and associated factors analysis of sudden cardiac death in 106 cases

Objective To investigate the pathological bases and associated factors of sudden cardiac death(SCD),to provide the clues of diagnosing and preventing SCD. Methods We retrospectively analyzed the clinical and pathological materials of SCD in 106 cases in our college,the cause and age of death, the predisposing factors, the pathological changes of SCD.Results The causes of SCD in 106 cases were found: coronary heart disease in 49 cases,myocarditis in 15 cases, myocardiosis in 20 cases, ruptured aortic interlamellar aneurysm in 7 cases, congenital malformation in 6 cases, KeShan disease in 2 cases, myocardial hypotrophy in 1 caes, mild cardiac changes in 6 cases.85 cases had predisposing factors. Coronary sudden death was the predominant causes of SCD in old age group. Among 49 cases died of coronary heart disease,the coronary artery atherosclerotic stenosis grade Ⅳ were found in 40 cases,of which 27 cases were with multiple branches involvement; acute myocardial infarction were found in 10 cases, and it was combined with old myocardial infarction (OMI) in 2 cases, simple OMI in 21 cases, myocardial ischemia in 18 cases. Myocarditis and myocardiosis were the major causes of SCD in younger group. There were 6 cases without obvious cardiac organic pathological changes, which were called negative autopsy or juvenile sudden unexplained death.Conclusions The foundermental measures of preventing SCD include preventing and treating coronary heart disease early, monitering the composition of atherosclerotic plaques,improving myocardial circulation. Reducing emotional stress is necessary to preventing SCD. Molecular genetic screening in negative autopsy cases can play an important role in explaining the cause of SCD and risk stratification of SCD.