Ishikawa Noboru, Takaso Marin, Akasaka Yoshihisa, Yamamoto Hitoshi, Ikegaya Hiroshi
Department of Histology and Developmental Biology, Tokyo Dental College, Tokyo, 101-0061, Japan; Department of Forensic Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan .
Department of Forensic Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan .
J Forensic Leg Med. 2018 Oct;59:50-55. doi: 10.1016/j.jflm.2018.08.001. Epub 2018 Aug 8.
Intramuscular bleeding of the tongue (ImBT) is occasionally found during post mortem examination. Despite its frequent reports, its cause has not yet been clarified. In this study, forensic autopsy data of 799 cadavers were examined and the relationship between ImBT and cause of death was investigated. A total of 74 cases showed ImBT (16 of 66 cases of fire fatality, 17 of 108 cases of drowning, 23 of 74 cases of asphyxiation, and 18 of 551 cases of other causes of death). The frequency of bleeding was significantly greater in cases with causes of death including fire fatality, drowning, and asphyxiation compared to those with other causes of death (p < 0.01). Among asphyxiation cases, ImBT was confirmed in two of five cases of typical hanging, three of 16 cases of atypical hanging, six of six cases of ligature strangulation, two of two cases of manual strangulation, eight of 38 cases of airway obstruction, and two of seven cases of oxygen deficiency. Among fire fatalities, the carboxyhemoglobin (CO-Hb) concentration of cases with ImBT was significantly lower than that in cases without ImBT (p < 0.01). In addition, the frequency of bleeding was significantly higher (p < 0.05) in cases where the blood cyanide concentration was 0.05 ppm or less. These observations suggested that ImBT during fire fatality occurs in a manner similar to that of ligature or manual strangulation, in which the flames cause the contraction and decrease in elasticity of the skin. Past reports indicated that bleeding frequency in cases of drowning did not significantly differ from that in cases with other causes of death. However, our cases showed a statistically higher incidence of bleeding compared to that in the other causes of death (p < 0.01). These results suggested that ImBT is a characteristic finding in cases of asphyxia and is an important evaluation for the diagnosis of death. When the relationship between ImBT and petechial hemorrhage was examined in three of the causes of death, no significant difference was observed between fire fatality and asphyxiation, but drowning was significantly different (p < 0.05). In cases without ImBT, the secretion of noradrenaline and adrenaline was significantly higher (p < 0.01). This finding suggests that it is unlikely that excessive secretion of catecholamine causes ImBT.
舌部肌肉内出血（ImBT）在尸检时偶尔会被发现。尽管有频繁的报道，但尚未阐明其原因。在本研究中，检查了799具尸体的法医尸检数据，并调查了ImBT与死亡原因之间的关系。共有74例出现ImBT（66例火灾致死中有16例，108例溺水中有17例，74例窒息中有23例，551例其他死因中有18例）。与其他死因的病例相比，火灾致死、溺水和窒息等死因的病例中出血频率显著更高（p<0.01）。在窒息病例中，5例典型缢死中有2例、16例非典型缢死中有3例、6例勒颈中有6例、2例扼颈中有2例、38例气道阻塞中有8例以及7例缺氧中有2例确认存在ImBT。在火灾致死病例中，有ImBT的病例的碳氧血红蛋白（CO-Hb）浓度显著低于无ImBT的病例（p<0.01）。此外，血氰化物浓度为0.05ppm或更低的病例中出血频率显著更高（p<0.05）。这些观察结果表明，火灾致死时的ImBT发生方式类似于勒颈或扼颈，即火焰导致皮肤收缩和弹性降低。过去的报道表明，溺水病例中的出血频率与其他死因的病例相比无显著差异。然而，我们的病例显示出血发生率在统计学上高于其他死因（p<0.01）。这些结果表明，ImBT是窒息病例中的一个特征性发现，是死亡诊断的重要评估指标。当在三种死因中检查ImBT与瘀点性出血之间的关系时，火灾致死和窒息之间未观察到显著差异，但溺水有显著差异（p<0.
