Suzuki Hideto, Tanifuji Takanobu, Abe Nobuyuki, Fukunaga Tatsushige
Tokyo Medical Examiner's Office, Tokyo Metropolitan Government, 4-21-18 Otsuka, Bunkyo-ku, Tokyo, Japan.
Leg Med (Tokyo). 2013 Jan;15(1):7-11. doi: 10.1016/j.legalmed.2012.08.003. Epub 2012 Sep 13.
Medical examiners and forensic pathologists often encounter emaciated bodies in postmortem examinations. However, the main disease that caused death is often not clear and measures to prevent the unexpected death of malnourished persons have not been established. In this study, we examined the underlying causes of death among a large number of forensic autopsy cases that showed emaciation to clarify the features of sudden, unexpected death in malnourished persons.
Documents of autopsy cases without putrefaction handled during 2007-2010 by the Tokyo Medical Examiner's Office were reviewed (n=7227). The body mass index (BMI) was calculated for each case. The causes of death for cases with severe malnutrition (BMI<16; n=885) were closely examined.
About 70% of all deaths in malnourished cases (BMI<16) was due to disease, and the causative diseases are more varied than in those with less severe malnutrition and those without malnutrition (BMI⩾16). A higher proportion of malnutrition as the cause of death was observed in younger persons for both sexes, and a higher proportion of having a history of psychiatric diseases was observed in younger deceased women. In addition, a higher proportion of alcohol-related digestive diseases was observed especially in younger men, some of whom had a history of alcohol dependence. On the other hand, the proportion of organic diseases, such as neoplasms and gastroduodenal ulcer, was higher in older deceased persons, especially among men. Around 70% of all respiratory diseases comprised pneumonia in both sexes. Among non-disease-related causes of death, poisoning was the most frequent cause in women under 55years old (35.3%), with the majority having had a history of psychiatric disease.
Because autopsy cases of malnourished persons show various causes of death, physicians have to pay more attention in making death diagnosis in such cases. From a preventative point of view, early detection of organic diseases, a better approach toward managing psychiatric diseases, and implementation of vaccination for pneumonia will contribute to reduction of future unexpected deaths among malnourished persons.
法医和病理学家在尸检时经常会遇到消瘦的尸体。然而，导致死亡的主要疾病往往并不明确，且尚未制定预防营养不良者意外死亡的措施。在本研究中，我们检查了大量呈现消瘦的法医尸检案例的潜在死因，以阐明营养不良者突然意外死亡的特征。
回顾了东京法医办公室在2007年至2010年期间处理的未腐败尸检案例文件（n = 7227）。计算每个案例的体重指数（BMI）。对严重营养不良（BMI < 16；n = 885）的案例的死因进行了仔细检查。
营养不良案例（BMI < 16）中约70%的死亡是由疾病导致的，与不太严重营养不良者和无营养不良者（BMI⩾16）相比，致病疾病更多样化。在男女较年轻者中，营养不良作为死因的比例更高，在较年轻的已故女性中，有精神疾病史的比例更高。此外，尤其在较年轻男性中，与酒精相关的消化系统疾病比例更高，其中一些人有酒精依赖史。另一方面，在较年长的死者中，尤其是男性中，肿瘤和胃十二指肠溃疡等器质性疾病的比例更高。在所有呼吸系统疾病中，约70%为肺炎，男女皆是。在与疾病无关的死因中，中毒是55岁以下女性最常见的死因（35.3%），大多数人有精神疾病史。
由于营养不良者的尸检案例显示出各种死因，医生在对此类案例进行死亡诊断时必须更加注意。从预防的角度来看，早期发现器质性疾病、更好地管理精神疾病以及实施肺炎疫苗接种将有助于减少未来营养不良者的意外死亡。
