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

为了分析意外猝死（SUD），特别是心脏性猝死病例的生前病理生理状态，我们检查了从自庆大学医学部法律的医学系尸检病例中获得的尸体血液中的临床实验室参数。为探讨冠状动脉粥样硬化青年SUD的发病机制，我们用PCR方法检测了尸体血中胆固醇酯转运蛋白（CETP）基因突变。此外，我们分析了心肌线粒体DNA（mDNA）突变的心脏性猝死的情况下。结果表明，尸体血中LDH、CPK、GOT、GPT和肌红蛋白的浓度异常增高，这是一种死后变化，这些指标对早期心肌缺血的诊断没有价值。在40例明显冠状动脉粥样硬化患者中，CETP基因均未检出纯合子或杂合子，提示高密度脂蛋白胆固醇（HDL-C）在我们的病例中可能并不明显升高。此外，我们发现在我们的情况下，心肌mDNA的缺失或突变，无论心脏性猝死。但缺失的mDNA频率与心源性猝死无明显相关性。

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.