不稳定冠状动脉粥样斑块病理特征及分类  

Pathological Characteristics and Classification of Unstable Coronary Atheroscle⁃rotic Plaques

作　　者：邢运虹 李洋 王文政 王亮亮 孙乐乐 杜秋香[1] 曹洁[1] 何光龙 孙俊红[1] XING Yun-hong;LI Yang;WANG Wen-zheng;WANG Liang-liang;SUN Le-le;DU Qiu-xiang;CAO Jie;HE Guang-long;SUN Jun-hong(School of Forensic Medicine,Shanxi Medical University,Jinzhong 030600,Shanxi Province,China;In-stitute of Forensic Science,Ministry of Public Security,Beijing 100038,China;Judical Appraisal Center of Shanxi Medical University,Jinzhong 030600,Shanxi Province,China)

机构地区：[1]山西医科大学法医学院,山西晋中030600 [2]公安部鉴定中心,北京100038 [3]山西医科大学司法鉴定中心,山西晋中030600

出　　处：《法医学杂志》2024年第1期59-63,共5页Journal of Forensic Medicine

基　　金：中央级科研院所基本科研业务费资助项目(2022JB016);国家重点研发计划资助项目(2018YFC0807203);山西省科技创新人才团队专项资助项目(202204051001025)。

摘　　要：冠状动脉粥样硬化性心脏病猝死的法医学重要诊断指标如急性或慢性心肌缺血改变,有时由于死亡过程短暂、组织缺少反应时间,使得缺血部位定位困难,部分案件中死者首次发病即猝死,导致法医难以准确作出诊断。然而临床医学对于冠状动脉不稳定斑块的研究揭示了其病变引发的冠状动脉痉挛、血栓形成在冠心病猝死过程中所起的关键作用。本文主要归纳整理了基于临床医学研究的不稳定冠状动脉粥样斑块的病理特征,包括斑块破裂、斑块侵蚀和钙化结节,以及导致斑块不稳定的影响因素,并简述粥样斑块研究进展与研究技术方法,以期通过诊断冠状动脉粥样斑块的不同病理状态,完善冠心病猝死死亡机制研究,提高冠心病猝死法医学诊断的准确性。Important forensic diagnostic indicators of sudden death in coronary atherosclerotic heart disease,such as acute or chronic myocardial ischemic changes,sometimes make it difficult to locate the ischemic site due to the short death process,the lack of tissue reaction time.In some cases,the deceased died of sudden death on the first-episode,resulting in difficulty for medical examiners to make an accurate diagnosis.However,clinical studies on coronary instability plaque revealed the key role of coronary spasm and thrombosis caused by their lesions in sudden coronary death process.This paper mainly summarizes the pathological characteristics of unstable coronary plaque based on clinical medical research,including plaque rupture,plaque erosion and calcified nodules,as well as the influencing factors leading to plaque instability,and briefly describes the research progress and technique of the atherosclerotic plaques,in order to improve the study on the mechanism of sudden coronary death and improve the accuracy of the forensic diagnosis of sudden coronary death by diagnosing different pathologic states of coronary atherosclerotic plaques.

关 键 词：法医病理学 心脏性猝死 冠状动脉粥样硬化性心脏病 粥样斑块 病理特征 综述 

分 类 号：R89[医药卫生—法医学] DF795.1[医药卫生—临床医学] D919.1[政治法律—诉讼法学]