Virmani R, Robinowitz M, Smialek J E, Smyth D F
Department of Cardiovascular Pathology, Armed Forces Institute of Pathology, Washington, DC 20306-6000.
Am Heart J. 1988 May;115(5):1068-76. doi: 10.1016/0002-8703(88)90078-6.
From September 1983 through November 1986, autopsies were performed on 6810 patients at the Office of the Maryland Medical Examiners; of these 40 had detectable cocaine, its metabolites, or both in body fluids. These patients were divided into two groups: natural cocaine-associated deaths (31 patients, mean age 28 +/- 5 years, blood level of cocaine 5.3 +/- 8.1 mg/L) and homicide deaths with detectable cocaine (nine patients, mean age 33 +/- 8 years, blood level of cocaine 0.3 +/- 0.3 mg/L). Cocaine-associated deaths were compared to a control group of 27 victims of sudden traumatic death (mean age 34 +/- 5 years). Total thrombotic occlusion of the left anterior descending coronary artery overlying mild coronary atherosclerosis occurred in one patient with cocaine-associated death. Results of histologic examination showed myocarditis (mononuclear infiltrate) in 8 of 40 (20%) patients dying with detectable cocaine in body fluids compared to 1 of 27 victims of sudden traumatic death (3.7%, p less than or equal to 0.05). Contraction band necrosis occurred in 25% of cocaine-associated deaths compared to a 41% incidence among victims of sudden traumatic death. We conclude that myocarditis occurs frequently in patients dying of cocaine abuse and may represent microvascular injury.
从1983年9月至1986年11月，马里兰州法医办公室对6810名患者进行了尸检；其中40名患者的体液中可检测到可卡因、其代谢物或两者皆有。这些患者被分为两组：自然发生的与可卡因相关的死亡（31名患者，平均年龄28±5岁，可卡因血药浓度5.3±8.1mg/L）和可检测到可卡因的他杀死亡（9名患者，平均年龄33±8岁，可卡因血药浓度0.3±0.3mg/L）。将与可卡因相关的死亡与27名突然创伤性死亡受害者的对照组（平均年龄34±5岁）进行比较。1名与可卡因相关死亡的患者出现了覆盖轻度冠状动脉粥样硬化的左前降支冠状动脉完全血栓闭塞。组织学检查结果显示，40名（20%）体液中可检测到可卡因的死亡患者中有8名出现心肌炎（单核细胞浸润），而27名突然创伤性死亡受害者中有1名出现心肌炎（3.7%，p≤0.05）。收缩带坏死在25%的与可卡因相关的死亡中出现，而在突然创伤性死亡受害者中的发生率为41%。我们得出结论，心肌炎在死于可卡因滥用的患者中经常发生，可能代表微血管损伤。
