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心包液和胸水在脓毒症尸检诊断中的作用

Usefulness of pericardial and pleural fluids for the postmortem diagnosis of sepsis.

作者信息

Palmiere Cristian, Egger Coraline

机构信息

University Center of Legal Medicine, Lausanne University Hospital, Rue du Bugnon 21, 1011 Lausanne, Switzerland.

University Center of Legal Medicine, Lausanne University Hospital, Rue du Bugnon 21, 1011 Lausanne, Switzerland.

出版信息

J Forensic Leg Med. 2014 Nov;28:15-8. doi: 10.1016/j.jflm.2014.09.006. Epub 2014 Sep 19.

Abstract

The purpose of this study was to evaluate the postmortem distributions of procalcitonin (PCT), C-reactive protein (CRP), soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) and soluble interleukin-2 receptor (sIL-2R) levels in postmortem serum from femoral blood, pericardial fluid and pleural fluid in a series of sepsis-related fatalities (12 subjects) and control cases (20 subjects) that underwent medico-legal investigations. Our aim was to assess the diagnostic potential of the results obtained from pericardial and pleural fluid analysis in identifying sepsis-related deaths. All sepsis-related cases had a documented, clinical diagnosis that was established in vivo during hospitalization. Pneumonia was the main infectious focus identified during autopsy and histology. Pseudomonas aeruginosa, Klebsiella pnemoniae and Escherichia coli were the most commonly identified bacteria in blood and lung tissue cultures. The preliminary results corroborate the usefulness of PCT, CRP, sTREM-1 and sIL-2R determination in postmortem serum for the identification of sepsis-related deaths. Moreover, the data suggest that, as far as PCT, CRP, sTREM-1 and sIL-2R measurements are concerned, pericardial and pleural fluids can be considered suitable alternatives to postmortem serum should femoral blood prove unavailable at autopsy.

摘要

本研究的目的是评估在一系列脓毒症相关死亡病例(12例)和接受法医调查的对照病例(20例)中,股骨血、心包液和胸液的死后血清中降钙素原(PCT)、C反应蛋白(CRP)、髓系细胞触发受体-1(sTREM-1)和可溶性白细胞介素-2受体(sIL-2R)水平的死后分布情况。我们的目的是评估心包液和胸液分析结果在识别脓毒症相关死亡中的诊断潜力。所有脓毒症相关病例均有记录在案的临床诊断,该诊断是在住院期间在体内确立的。肺炎是尸检和组织学检查中确定的主要感染病灶。铜绿假单胞菌、肺炎克雷伯菌和大肠杆菌是血液和肺组织培养中最常鉴定出的细菌。初步结果证实了死后血清中PCT、CRP、sTREM-1和sIL-2R测定在识别脓毒症相关死亡中的有用性。此外,数据表明,就PCT、CRP、sTREM-1和sIL-2R测量而言,如果尸检时无法获得股骨血,心包液和胸液可被视为死后血清的合适替代物。

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