Dipartimento di Morfologia Umana e Scienze Biomediche, Sezione di Medicina Legale e delle Assicurazioni, Università degli Studi di Milano, Via Luigi Mangiagalli, 37, 20133 Milano, Italy.
Forensic Sci Int. 2012 Nov 30;223(1-3):78-86. doi: 10.1016/j.forsciint.2012.08.004. Epub 2012 Aug 28.
Myocarditis can be either the cause of the death of a person or just an incidental finding during the autopsy and the following histological examinations. To establish whether a single myocarditis is a lethal or just an incidental pathology a very careful grading is always mandatory. The aim of the present work is thus to test the hypothesis about the reliability of an evidence-based distinction between the lethal myocarditis and the incidental myocarditis. The present work compares clinical and histological features from two different groups of myocarditis. Group A is composed of patients having myocarditis at the time of death, who certainly died from other reasons (i.e.: death by head gunshot with no survival time). Group B is composed of patients who died having a myocarditis as the only pathological evidence at the autopsy and the following histological and toxicological examinations and then who died because of the myocarditis. The lethal myocarditis and the incidental myocarditis differ statistically about last days' anamnesis, acute findings in the macroscopic analysis of the heart, neutrophilic infiltration, myocite necrosis, multiple sites interstitial oedema and perivascular cuffs. Such variables can be summarized in a scoring system able to quantitatively separate the lethal myocarditis from the incidental myocarditis. Such a reliable scoring system develops far behind the isolated grading of the myocite necrosis, even though the myocite necrosis should always be considered as a pivot variable for distinguishing lethal myocarditis from incidental myocarditis. The proposed scoring system is very easy to use and it is also appreciably money-sparing with its foundations in the simple combination of clinical anamnesis, autopsy and basic histology. Its routinary application could implement the objectivity in the forensic grading of myocarditis.
心肌炎既可以是导致人死亡的原因，也可以是尸检和随后的组织学检查中的偶然发现。为了确定单一心肌炎是致命的还是偶然的病理学，总是需要进行非常仔细的分级。因此，本工作旨在检验关于基于证据的致命性心肌炎和偶发性心肌炎之间区别的可靠性的假设。本工作比较了两组不同心肌炎患者的临床和组织学特征。A 组由在死亡时患有心肌炎的患者组成，他们肯定是因其他原因死亡（即：头部枪击，无存活时间）。B 组由在尸检和随后的组织学和毒理学检查中仅发现心肌炎作为唯一病理学证据的患者组成，然后因心肌炎而死亡。致命性心肌炎和偶发性心肌炎在最近病史、心脏大体分析中的急性发现、中性粒细胞浸润、心肌细胞坏死、多处间质水肿和血管周围袖口等方面存在统计学差异。这些变量可以总结为一个评分系统，能够定量地区分致命性心肌炎和偶发性心肌炎。尽管心肌细胞坏死应该始终被视为区分致命性心肌炎和偶发性心肌炎的关键变量，但这种可靠的评分系统远落后于孤立的心肌细胞坏死分级。所提出的评分系统非常易于使用，并且基于临床病史、尸检和基本组织学的简单组合，也具有明显的节省成本的优点。其常规应用可以在法医心肌炎分级中实现客观性。
