Zhu B L, Ishida K, Quan L, Taniguchi M, Oritani S, Kamikodai Y, Fujita M Q, Maeda H
Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, 545-8585, Osaka, Japan.
Forensic Sci Int. 2001 Jan 15;115(3):183-8. doi: 10.1016/s0379-0738(00)00326-1.
To evaluate pathophysiological significance of post-mortem urinary myoglobin levels in determining the cause of death, we investigated 210 forensic autopsy cases, partially in comparison with serum levels. Post-mortem serum myoglobin levels were extraordinary high in most cases possibly due to post-mortem change. Urinary myoglobin levels did not correlate with the serum levels, showing possible post-mortem elevation in cases of a prolonged post-mortem period over 48h. A high (>1000 ng/ml), moderate (100-1000 ng/ml), slight (50-100 ng/ml) and not significant (<50 ng/ml) elevation of urinary myoglobin were observed in 26, 43, 31 and 110 cases, respectively. Half the highly elevated cases were those with a survival time over 24h. In cases of minor muscle injury such as head trauma, elevation of urinary myoglobin level was closely related to longer survival. In acute/subacute deaths with a post-mortem interval within 48h, a significant difference was observed in relation to the blood carboxyhemoglobin (COHb) levels of fire victims: myoglobinuria over 100 ng/ml was more frequently and markedly observed in cases with COHb below 60% than over 60%, suggesting muscle damage in fatal burns. Similar elevation was observed in heat stroke victims, and also in some cases of acute and subacute death from polytrauma, asphyxiation, drowning, electricity and spontaneous cerebral bleeding, but not in myocardial infarction. Thus, it was suggested that high post-mortem urinary myoglobin levels in acute and subacute death cases may be a possible indicator of antemortem massive skeletal muscle damage as well as exertional muscle hyperactivity or convulsive disorders associated with hypoxia.
为评估死后尿肌红蛋白水平在确定死因方面的病理生理意义，我们调查了210例法医尸检病例，部分病例与血清水平进行了比较。大多数病例中死后血清肌红蛋白水平异常高，可能是由于死后变化所致。尿肌红蛋白水平与血清水平不相关，在死后间隔超过48小时的病例中显示出可能的死后升高。分别在26、43、31和110例病例中观察到尿肌红蛋白水平高（>1000 ng/ml）、中度（100 - 1000 ng/ml）、轻度（50 - 100 ng/ml）和无显著升高（<50 ng/ml）。高度升高病例中有一半是存活时间超过24小时的。在诸如头部外伤等轻度肌肉损伤病例中，尿肌红蛋白水平升高与较长的存活时间密切相关。在死后间隔在48小时内的急性/亚急性死亡病例中，火灾受害者的血液碳氧血红蛋白（COHb）水平存在显著差异：COHb低于60%的病例中，尿肌红蛋白尿超过100 ng/ml的情况比超过60%的病例更频繁且明显，提示致命烧伤中有肌肉损伤。中暑受害者以及一些因多发伤、窒息、溺水、电击和自发性脑出血导致急性和亚急性死亡的病例中也观察到类似升高，但心肌梗死病例中未观察到。因此，提示急性和亚急性死亡病例中死后尿肌红蛋白水平高可能是生前大量骨骼肌损伤以及与缺氧相关的运动性肌肉活动亢进或惊厥性疾病的一个可能指标。
