Dorandeu A, Perie G, Jouan H, Leroy B, Gray F, Durigon M
Department of Pathology and Forensic Medicine, Hôpital Raymond Poincaré, 104 boulevard R. Poincaré, F-92380, Garches, France.
Int J Legal Med. 1999;112(5):280-6. doi: 10.1007/s004140050250.
In the context of chronic physical child abuse, two entities have been described based on macroscopical and radiological criteria: the battered baby syndrome and the shaken baby syndrome. However, in some autopsy cases, clinico-radiological information may not be available. In these cases, histological examinations are necessary to look for sequelae of repeated haemorrhages, particularly in organs likely to have suffered traumatisms such as the lungs, or in organs belonging to the mononucleated macrophage resorption system, such as the liver and the spleen. We examined a series of 15 young children who died from proven chronic child abuse and compared them with 15 sex and age-matched control subjects who died from natural causes with no history of child abuse. Using Perl's stain for iron, we identified haemosiderin deposits in pulmonary, hepatic and splenic samples and the deposits were evaluated qualitatively and quantitatively. Haemosiderin deposits were significantly (P < 0.001) more abundant in the lungs and liver of the chronic abuse victims than in those of the control subjects. However, they were not significantly more abundant in the spleens of child abuse victims than in controls. We conclude that haemosiderin deposits in lungs and liver could be proposed as a marker for chronic physical child abuse. This study stresses the importance of systematic histological examination to look for pulmonary and hepatic haemosiderin deposits in cases in which chronic child abuse is suspected.
在慢性身体虐待儿童的背景下，根据宏观和放射学标准描述了两种情况：受虐婴儿综合征和摇晃婴儿综合征。然而，在一些尸检案例中，临床放射学信息可能无法获取。在这些情况下，组织学检查对于寻找反复出血的后遗症是必要的，特别是在可能遭受创伤的器官如肺部，或在属于单核巨噬细胞吸收系统的器官如肝脏和脾脏中。我们检查了一系列15名死于经证实的慢性儿童虐待的幼儿，并将他们与15名性别和年龄匹配、死于自然原因且无儿童虐待史的对照受试者进行比较。使用Perl铁染色法，我们在肺、肝和脾样本中鉴定出含铁血黄素沉积，并对这些沉积进行了定性和定量评估。慢性虐待受害者的肺和肝中的含铁血黄素沉积明显（P < 0.001）比对照受试者的更丰富。然而，儿童虐待受害者脾脏中的含铁血黄素沉积并不比对照组明显更丰富。我们得出结论，肺和肝中的含铁血黄素沉积可被提议作为慢性身体虐待儿童的一个标志物。本研究强调了在怀疑慢性儿童虐待的病例中进行系统组织学检查以寻找肺和肝中含铁血黄素沉积的重要性。
