Goldwater Paul N
Microbiology & Infectious Diseases Department, the Women's & Children's Hospital, Discipline of Paediatrics, Children, Youth & Women's Health Service, North Adelaide, South Australia 5006, Australia.
Pediatr Dev Pathol. 2008 Nov-Dec;11(6):450-5. doi: 10.2350/08-01-0404.1.
The objective of this study was to provide a predictive tool to assist forensic and pediatric pathologists in the diagnosis of sudden unexpected infant death and to discuss the pathogenesis of intrathoracic petechial hemorrhages through a retrospective autopsy report review of 174 sudden infant death syndrome (SIDS) cases (2004 definition) and 67 age-matched comparison deaths. The setting was a qualitative assessment (presence or absence) of macroscopic intrathoracic petechiae in SIDS and age-matched comparison of sudden unexpected deaths that occurred in the late 1980s and early 1990s. Sensitivity, specificity, and positive and negative predictive values for thymic, pleural, and epicardial petechial hemorrhages were developed. Results showed 89.5%, 80%, and 79.9% SIDS (<12 months of age) had thymic, pleural, and epicardial petechiae, respectively, compared with 47.6%, 47.5% and 43.6% in non-SIDS deaths, respectively. Respective odds ratios were: 9.4 (4.5 to 19.9), 4.6 (2.3 to 9.1), 5.3 (2.6 to 10.8). When all 3 intrathoracic organ sites contain macroscopic petechiae, this is 84.9% predictive of SIDS; when all 3 sites have no detectable petechiae this is 93.1% predictive of a non-SIDS diagnosis. Thus, we conclude that careful assessment of intrathoracic petechiae at autopsy is likely to be diagnostically useful in the assessment of sudden unexplained infant death.
本研究的目的是提供一种预测工具，以协助法医和儿科病理学家诊断婴儿猝死综合征，并通过对174例婴儿猝死综合征（2004年定义）病例和67例年龄匹配的对照死亡病例的回顾性尸检报告，探讨胸内瘀点出血的发病机制。研究背景是对20世纪80年代末和90年代初发生的婴儿猝死综合征和年龄匹配的意外猝死进行宏观胸内瘀点定性评估（存在或不存在）。得出了胸腺、胸膜和心外膜瘀点出血的敏感性、特异性、阳性和阴性预测值。结果显示，分别有89.5%、80%和79.9%的婴儿猝死综合征（<12月龄）有胸腺、胸膜和心外膜瘀点，而非婴儿猝死综合征死亡病例的这一比例分别为47.6%、47.5%和43.6%。各自的比值比为：9.4（4.5至19.9）、4.6（2.3至9.1）、5.3（2.6至10.8）。当所有3个胸内器官部位均有宏观瘀点时，这对婴儿猝死综合征的预测率为84.9%；当所有3个部位均未检测到瘀点时，这对非婴儿猝死综合征诊断的预测率为93.1%。因此，我们得出结论，尸检时仔细评估胸内瘀点可能对评估不明原因婴儿猝死具有诊断价值。
