Radu Ioana, Farcas Anca Otilia, Voidazan Septimiu, Radu Carmen Corina, Brinzaniuc Klara
Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania.
Department of Forensic Medicine Emergency County Hospital, "Constantin Opriș" Baia Mare, 430031 Baia Mare, Romania.
Diseases. 2025 Jan 6;13(1):8. doi: 10.3390/diseases13010008.
BACKGROUND/OBJECTIVES: Sudden cardiac death (SCD) constitutes approximately 50% of cardiovascular mortality. Numerous studies have established an interrelation and a strong association between SCD and pulmonary diseases, such as chronic obstructive pulmonary disease (COPD). The aim of this study is to examine the presence of more pronounced cardiopulmonary histopathological changes in individuals who died from SCD compared to the histopathological changes in those who died from violent deaths, in two groups with comparable demographic characteristics, age and sex.
This retrospective case-control study investigated the histopathological changes in cardiac and pulmonary tissues in two cohorts, each comprising 40 cases of SCD and 40 cases of violent death (self-inflicted hanging). Forensic autopsies were conducted at the Maramureș County Forensic Medicine Service, Romania, between 2019 and 2020.
The mean ages recorded were 43.88 years (SD 5.49) for the SCD cohort and 41.98 years (SD 8.55) for the control cohort. In the SCD cases, pulmonary parenchyma exhibited inflammatory infiltrate in 57.5% (23), fibrosis in 62.5% (25), blood extravasation in 45% (18), and vascular media thickening in 37.5% (15), compared to the control cohort, where these parameters were extremely low. In myocardial tissue, fibrosis was identified in 47.5% (19) and subendocardial adipose tissue in 22.5% (9) of the control cohort.
A close association exists between SCD and the histopathological alterations observed in the pulmonary parenchyma, including inflammation, fibrosis, emphysema, blood extravasation, stasis, intimal lesions, and vascular media thickening in intraparenchymal vessels. Both the histopathological modifications in the pulmonary parenchyma and vessels, as well as those in myocardial tissue, were associated with an increased risk of SCD, ranging from 2.17 times (presence of intimal lesions) to 58.50 times (presence of interstitial and perivascular inflammatory infiltrate in myocardial tissue).
背景/目的：心源性猝死（SCD）约占心血管疾病死亡率的50%。大量研究已证实SCD与肺部疾病（如慢性阻塞性肺疾病（COPD））之间存在相互关系和紧密联系。本研究的目的是在两组人口统计学特征、年龄和性别相当的人群中，比较死于SCD者与死于暴力死亡者的组织病理学变化，以检验死于SCD的个体是否存在更明显的心肺组织病理学变化。
这项回顾性病例对照研究调查了两个队列中心脏和肺部组织的组织病理学变化，每个队列包括40例SCD病例和40例暴力死亡（自缢）病例。2019年至2020年期间，在罗马尼亚马拉穆列什县法医服务处进行了法医尸检。
SCD队列的平均年龄记录为43.88岁（标准差5.49），对照队列的平均年龄记录为41.98岁（标准差8.55）。在SCD病例中，肺实质出现炎症浸润的占57.5%（23例），纤维化的占62.5%（25例），出血的占45%（18例），血管中层增厚的占37.5%（15例），而在对照队列中，这些参数极低。在心肌组织中，对照队列中47.5%（19例）发现纤维化，22.5%（9例）发现心内膜下脂肪组织。
SCD与肺实质中观察到的组织病理学改变密切相关，包括炎症、纤维化、肺气肿、出血、淤血、内膜病变和实质内血管的血管中层增厚。肺实质和血管的组织病理学改变以及心肌组织的改变均与SCD风险增加相关，风险增加范围从2.17倍（存在内膜病变）到58.50倍（心肌组织存在间质和血管周围炎症浸润）。
