深圳市南山区外来工青壮年猝死尸检病理分析

Pathological analysis of sudden death of young migrant workers in Nan-shan District of Shenzhen City

目的在对深圳市南山区青壮年外来工猝死流行病学特征进行调查的基础上,进一步对心源性猝死病例心肌缝隙连接蛋白43(Cx43)检测,观察其在心肌的分布特征,探讨其分布变化与猝死的关联性。方法筛选尸检案例30例,分为冠心病心肌梗死组(5例)、心脏传导系统病变组(5例)、肥厚型心肌病组(6例)及对照组(14例)。采用免疫组织化学染色和图像分析技术对不同组别Cx43阳性单位进行定量检测,分析其阳性表达在各组间的差异,所得数据行统计学分析。结果冠心病心肌梗死组、心脏传导系统病变组和肥厚型心肌病组共占猝死患者的53.3%,这3组患者Cx43染色在心肌闰盘处明显减弱或缺失,胞质内散在或心肌边缘处可见少量着色;对照组未见明显变化。结论冠心病心肌梗死组、心脏传导系统病变组和肥厚型心肌病组占猝死较高比例,且这3组患者Cx43分布发生了变化,推测是猝死性心律失常的结构基础。

Objective To investigate the epidemiological characteristics of sudden death of young migrant workers in Nanshan District on the cases of sudden cardiac death,myocardial connexin 43 （Cx43） detection,to observe its distribu- tion in the myocardium,the relationship between the changes of distribution and sudden death.Methods 30 cases of autopsy case screening were divided into 4 groups,including coronary heart disease myocardial infarction group （5 cases）, cardiac conduction system disease group （5 cases）,hypertrophic cardiomyopathy group （6 cases） and control group （14 cases）.Quantitative detection of Cx43 positive units of different groups by immunohistochemical staining and image analysis technique,the expression difference in each group was analyzed,and the data were analyzed statistically.Re- sults Coronary heart disease myocardial infarction,cardiac conduction system disease group and hypertrophic cardiomy- opathy group accounted for sudden death in patients with 53.3%,these three groups of patients in Cx43 staining of my- ocardial intercalated disk,significantly reduced or missing,in the cytoplasm of a small amount of coloring in bulk or myocardial edge;the control group had no obvious change.Conclusion Coronary heart disease myocardial infarction,car- diac conduction system disease group and hypertrophic cardiomyopathy group accounted for a higher proportion of sudden death,and the three groups of patients with Cx43 distribution has changed,that is the structural basis of sudden arrhythmia.