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

婴儿猝死综合征病理诊断的进展可能意味着如何通过精确细致的尸检消除广义婴儿猝死综合征中可诊断的病理死因，关闭狭窄婴儿猝死综合征的特征。在这些情况下，要从广泛的小岛屿发展中国家中排除的最重要的疾病之一可能是病毒感染。为了诊断婴儿猝死尸检病例中的病毒感染，我们从以下几个角度进行了分析和研究。对52例1岁以下婴幼儿猝死尸检病例的围生期危险因素进行统计分析。将52例1岁以下婴幼儿猝死病例分为病毒感染组、婴儿猝死综合征组和对照组，主要根据Shefffield‘s出生评分系统分析围产期危险因素。在我们的一系列分析中，我们发现病毒感染改变了每个围产期危险因素的分布，谢菲尔德出生…的应用结论：1.更多的评分系统对小儿麻痹症的辅助诊断不够充分，因为在我们的小儿麻痹症组中，仅有1例在谢菲尔德系统中被评价为小儿麻痹症。组织学检查对病毒性肺炎和心肌炎的诊断有价值。在我们的研究中，34.8%的婴儿猝死病例用免疫荧光法检测了病毒抗原。检出的病毒株为B型流感病毒、柯萨奇B型病毒和巨细胞病毒。在这些病例中，我们分析了肺和心脏的有价值的组织学结果，以诊断病毒感染。随后，用这些组织学标准观察原因不明的婴儿猝死的尸检病例。因此，77.4%的病例被诊断为疑似病毒性肺炎或病毒性心肌炎，其余病例被诊断为SIDS。这些组织学标准可能有助于对需要进行更准确病毒检查的病例进行筛查。DNA分析在婴儿猝死病例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。对流感、柯萨奇B组病毒、疱疹病毒、副流感病毒等进行了检测，并将这些DNA探针应用于婴幼儿突发性DATH病例的福尔马林固定和石蜡包埋的肺组织切片中特异性病毒基因组的检测。结果表明，原位杂交法能够在病理切片上特异性地检测病毒基因组。(2)新型DNA探针的研制用于诊断婴儿猝死病例的病毒感染。(3)应用聚合酶链式反应方法诊断婴儿猝死病例的病毒感染。我们首次建立了以乳头状瘤病毒为模型的特异性病毒株的PCR鉴定方法。另一方面，我们开发了针对巨细胞病毒和肠道病毒的新的DNA产物，并将其应用于实际案例中，我们将在未来更深入地继续这一领域的实验。较少

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