云南省宁蒗县不明原因猝死病例调查研究

目的探讨云南省宁蒗县不明原因猝死病例的死因。方法对云南省宁蒗县不明原因猝死病例进行现场流行病学调查,采集样本进行病理学、病毒学等相关检验及分析研究。结果猝死病例的临床表现类似阿-斯综合征发作,心电图示窦性心动过速、Q-T间期延长、ST段改变、室颤,病理检验主要以心肌间质水肿、弥漫性炎细胞浸润、心肌纤维断裂、心肌灶性坏死以及其他脏器炎细胞浸润等改变为主;同发病例的临床表现亦类似阿-斯综合征发作,心电图示Q-T间期延长、室扑,粪便标本病毒分离阴性,但是从中检测到了埃可病毒11型(ECHO11)的基因片段。结论猝死病例及同发病例与既往报道的云南地方性爆发性心肌炎类似,心肌炎性改变可能诱发快速心律失常,引起阿-斯综合征发作,最后导致发病甚至猝死。

The investigation and research of an unknown-cause sudden death cases in Ninglang County, Yunnan Province

Objective To explore the etiology of sudden death with unknown-cause occurred in Ninglang county,Yunnan Province.Methods The epidemiology investigation of the sudden death cases was conducted, while specimens was collected,virology research was carried out.Results The clinical features of the sudden deaths cases were similar to the Adams-Strokes syndrome,with abnormal ECG of sinus tachycardia,prolonged QT interval,ST-T change,ventricular fibrillation.The pathological changes of the heart included myocardial interstitial edema,diffusing lymphocyte infiltration,broken and granular degeneration of cardiac muscle fibers.The clinical features of the survivals,although with similar Adams-Strokes syndrome and the abnormal ECG,the stool specimen collected was negative for the virus;still,we identified the fragment genome of ECHO1 1 from the stool specimen. Conclusions The clinical features,electrocardiogram changes,pathologic changes of those patients are similar to the features of the Yunnan endemic fulminant myocarditis reported in the past,the latter may induce tacky- arrhythmias,the onset of the Adams-Strokes syndrome,and finally sudden death.