Clinical laboratory analysis of cadaver blood from sudden unexpected death -especially focused on sudden cardiac death-

为了分析猝死，尤其是心脏性猝死的生前病理生理状态，我们检测了济济大学医学院法医学系尸检标本的临床实验室指标。为探讨青年冠状动脉粥样硬化症的发病机制，我们用聚合酶链式反应方法检测了身体血中胆固醇酯转运蛋白(CETP)基因突变。此外，我们还分析了心脏性猝死患者心肌中线粒体DNA(MDNA)的突变。结果表明，身体血中LDH、CPK、GOT、GPT和肌红蛋白浓度异常升高，对早期心肌缺血的诊断价值不大。在CETP基因分析方面，40例明显冠状动脉硬化患者均未检出纯合子或杂合子，提示高密度脂蛋白胆固醇(HDL-C)在本组病例中升高不明显。此外，我们在我们的病例中发现了心肌mDNA的缺失或突变，与心脏性猝死无关。然而，mDNA频率缺失没有对抗心脏性猝死的趋势。

In order to analyze the antemortem pathophysiological state in cases of sudden unexpected death (SUD), particularly of sudden cardiac death, we examined clinical laboratory parameters in cadaver blood obtained from autopsy cases at Department of Legal Medicine, the Jikei University School of Medicine. As a trial for the pathogenetic analysis of SUD in young persons with marked coronary arteriosclerosis, we identified cholesteryl ester transfer protein (CETP) gene mutations in cadaver blood by means of PCR method. Furthermore, we analyzed mitochondrial DNA (mDNA) mutations in cardiac muscle from the cases of sudden cardiac death. As results, serum concentration of LDH,CPK,GOT,GPT and myoglobin in cadaver blood was so abnormally increased as a postmortem changes that these parameters were not valuable for diagnosis of early myocardial ischemia. Concerning the CETP gene analysis, neither homozygote nor heterozygote was detected in 40 cases of marked coronary arteriosclerosis, indicating that high density lipoprotein cholesterol (HDL-C) may not so markedly increased in our cases. Furthermore, we found deletion or mutation of myocardial mDNA in our cases, regardless of sudden cardiac death. However, there was no tendency of deleted mDNA frequency against sudden cardiac death.