Department of Medical Sciences and Public Health, Section of Legal Medicine, University of Cagliari, Cagliari, Italy.
Department of Environmental, Biological and Pharmaceutical Sciences and Technologies, University of Campania "L. Vanvitelli", Caserta, Italy.
Sci Rep. 2021 May 12;11(1):10102. doi: 10.1038/s41598-021-89570-0.
The diagnosis of mechanical asphyxia remains one of the most difficult issues in forensic pathology. Asphyxia ultimately results in cardiac arrest (CA) and, as there are no specific markers, the differential diagnosis of primitive CA and CA secondary to asphyxiation relies on circumstantial details and on the pathologist experience, lacking objective evidence. Histological examination is currently considered the gold standard for CA post-mortem diagnosis. Here we present the comparative results of histopathology versus those previously obtained by H nuclear magnetic resonance (NMR) metabolomics in a swine model, originally designed for clinical purposes, exposed to two different CA causes, namely ventricular fibrillation and asphyxia. While heart and brain microscopical analysis could identify the damage induced by CA without providing any additional information on the CA cause, metabolomics allowed the identification of clearly different profiles between the two groups and showed major differences between asphyxiated animals with good and poor outcomes. Minute-by-minute plasma sampling allowed to associate these modifications to the pre-arrest asphyxial phase showing a clear correlation to the cellular effect of mechanical asphyxia reproduced in the experiment. The results suggest that metabolomics provides additional evidence beyond that obtained by histology and immunohistochemistry in the differential diagnosis of CA.
机械性窒息的诊断仍然是法医病理学中最困难的问题之一。窒息最终会导致心脏骤停（CA），由于没有特定的标志物，因此原发性 CA 和窒息继发 CA 的鉴别诊断依赖于环境细节和病理学家的经验，缺乏客观证据。组织学检查目前被认为是 CA 死后诊断的金标准。在这里，我们展示了组织病理学与之前在为临床目的设计的猪模型中通过 H 核磁共振（NMR）代谢组学获得的结果的比较，该模型暴露于两种不同的 CA 原因，即心室颤动和窒息。虽然心脏和大脑的显微镜分析可以识别 CA 引起的损伤，但不能提供任何关于 CA 原因的额外信息，而代谢组学可以在两组之间识别出明显不同的图谱，并显示出结局良好和不良的窒息动物之间的明显差异。每分钟进行血浆采样，将这些改变与窒息前的窒息阶段相关联，显示出与实验中复制的机械性窒息对细胞的影响之间的明确相关性。结果表明，代谢组学在 CA 的鉴别诊断中提供了组织学和免疫组织化学检查之外的额外证据。
