Forensic Pathological Study on Sudden Infant Death- Particularly Its Relation to Viral Infection.

婴儿猝死综合征（SIDS）病理诊断的进展，可能意味着如何通过精确细致的尸检，排除广义SIDS的可诊断病理性死因，从而缩小狭义SIDS的特征。在这些情况下，从广泛的SIDS中排除的最重要的疾病之一可能是病毒感染。为诊断婴儿猝死尸检病例中的病毒感染，我们从以下几个方面进行了分析和研究.婴儿猝死尸检病例围生期危险因素统计分析将52例1岁以下婴儿猝死尸检病例分为病毒感染组、SIDS组和对照组，主要按谢菲尔德出生评分系统分析围生期危险因素。在我们的一系列分析中，发现病毒感染改变了每一个围产期危险因素的分布，并且谢菲尔德分娩的应用 ...更多信息 评分系统对SIDS的辅助诊断不够充分，在我们的SIDS组中，只有1例在谢菲尔德评分系统中被评估为SIDS.对诊断病毒性肺炎和心肌炎有价值的组织学发现在我们的系列研究中，34.8%的婴儿猝死病例用免疫荧光法检测病毒抗原。检测到的病毒株为流感B、科萨基B和巨细胞病毒。在这些病例中，我们分析了肺和心脏中有价值的组织学检查结果，以诊断病毒感染。随后，尸检的情况下，婴儿猝死的原因不明，观察这些组织学标准。结果77.4%的病例被诊断为疑似病毒性肺炎或病毒性心肌炎，其余为SIDS，这些组织学指标可用于筛查病例，以便进行更精确的病毒检查. DNA分析在婴儿猝死病毒感染诊断中的应用(1)原位杂交法我们研制了针对几种病毒株的DNA探针，如：流感、柯萨奇B型、疱疹、副流感等，并将这些DNA探针用于检测婴儿突发性肺炎病例肺组织中特异性病毒基因组。结果表明，原位杂交技术可以在病理切片上特异性地检测到病毒基因组。(2)婴儿猝死病毒感染诊断新DNA探针的研制(3)应用PCR方法诊断婴儿猝死病例中的病毒感染，需要检查各病毒株的特异性，尤其是PCR方法。本研究首次建立了以乳头瘤病毒为模型的特异性PCR鉴定方法。另一方面，我们开发了抗巨细胞病毒和肠道病毒的新DNA探针，并将其应用于实际病例中，今后应继续加强这方面的实验。少

The advance in pathological diagnosis of sudden infant death syndrome (SIDS) may mean how we can eliminate the diagnosable pathological cause of death from the broad SIDS with precise and careful autopsy and close up the feature of narrow SIDS. In these situations, one of the most important discases to be excluded from broad SIDS may be viral infection. To diagnose the viral infection in autopsy cases of sudden infant death, we have ananlysed and studied from the following points of view.1. Statistical analyses of perinatal risk factors in autopsy cases of sudden infant death.52 infant victims under 1-year-old of autopsied sudden death cases was devided into three groups : viral infection group, SIDS group and control group, and analysed the perinatal risk factors mainly according to Sheffield's birth scoring system. In the series of our analyses, it was revealed that viral infection modified the distribution of each perinatal risk factor, and that the application of Sheffield's birth … More scoring system to supplemental diagnosis of SIDS was not so adequate, because only one case was evaluate as SIDS in Sheffield's system in our SIDS group.2. Valuable histological findings for the diagnosis of viral pneumonia and myocarditis.In our series, viral antigens were detected by using immunofluorescence in 34.8% of sudden infant death cases. The virus strains detected were Influenza B, Coxsackie B and Cytomegalovirus. In these cases we analysed the valuable histological findings in the lung and the heart for diagnosis of viral infection. Subsequently, autopsy cases of sudden infant death of unknown etiology were observed with these histological criteria. As a result, 77.4% of these cases were diagnosed as suspected viral pneumonia or viral myocarditis, and the rest as SIDS.These histological criteria may be useful for screening of cases to be done more precise viral examinations.3. Application of DNA analysis to diagnosis of viral infection in sudden infant death cases.(1) In situ hybridization methodWe developed DNA-probe against some kinds of virus strains, ex. Influenza, Coxsakie B, Herpes, Parainfluenza etc., and applied these DNA probe to detection of specific virus genome in formalin-fixed and paraffin-embedded sections of the lung from sudden infant dath cases. As a result, it was indicated that in situ hybridization was enough to detect specifically virus genome on the pathological sections.(2) Development of new DNA probe for diagnosis of viral infection in sudden infant death cases.(3) Application of PCR method to diagnosis of viral infection in sudden infant death cases.For these purpose, we have to check the specificity for each virus strain, particularly in PCR method. We developed firstly how to indentify specifically virus strain, papilloma virus as a model, by using PCR method. On the other hand, we developed new DNA prode against Cytomegalovirus and Enterovirus, and applied these to the practical cases, We should more intensively continue the experiments in these field in the future. Less