法医学杂志

法医学杂志 ›› 2019, Vol. 35 ›› Issue (1): 58-62.DOI: 10.12116/j.issn.1004-5619.2019.01.011

• 技术与应用 • 上一篇    下一篇

OCT对冠状动脉粥样硬化及心肌梗死的法医病理学辅助诊断

李洋1， 张宁2， 王成铭3， 何光龙1   

  1. 1. 公安部物证鉴定中心 法医病理损伤技术处，北京 100038； 2. 公安部物证鉴定中心 视频侦查技术处，北京 100038； 3. 清华大学物理系，北京 100084
  • 发布日期:2019-02-25 出版日期:2019-02-28
  • 通讯作者: 何光龙，男，副主任法医师，主要从事弥漫性轴索损伤、心脏性猝死、法医损伤、命案现场分析研究；E-mail：guanglong_he@163.com
  • 作者简介:李洋（1989—），男，主检法医师，主要从事心脏性猝死、毒品成瘾的法医病理学研究；E-mail：liyang@cifs.gov.cn
  • 基金资助:
    国家自然科学基金资助项目（61505034）；中央级科研院所基本科研业务费资助项目（2016JB041）

Application of OCT in the Forensic Pathological Diagnosis of Coronary Artery Atherosclerosis and Myocardial Infarction

LI Yang1, ZHANG Ning2, WANG Cheng-ming3, HE Guang-long1   

  1. 1. Department of Forensic Pathology and Traumatology, Institute of Forensic Science, Ministry of Public Security, PRC, Beijing 100038, China; 2. Department of Video Detection, Institute of Forensic Science, Ministry of Public Security, PRC, Beijing 100038, China; 3. Department of Physics, Tsinghua University, Beijing 100084, China
  • Online:2019-02-25 Published:2019-02-28

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摘要： 目的 研究光学相干断层扫描成像（optical coherence tomography，OCT）技术在法医学鉴定中辅助诊断冠状动脉粥样硬化及心肌梗死的应用价值。 方法 利用OCT及苏木素-伊红（hematoxylin-eosin，HE）染色方法检查5例冠心病猝死尸体的冠状动脉、心肌梗死组织病理学样本，并进行形态学、局部测量指标的统计学比较。 结果 在OCT影像中，冠状动脉各层边界清楚，粥样斑块与HE切片有良好的形态学对应关系。OCT影像中的正常心肌光信号较弱，呈高吸光性，而心肌梗死区纤维瘢痕组织内则显示出较强光信号，呈低吸光性。冠状动脉粥样斑块纤维帽厚度和中膜厚度在OCT与HE差异均无统计学意义（P>0.05），而OCT影像中陈旧性心肌梗死区光密度值（1 226.24±622.66）与正常心肌的光密度值（3 707.90±962.98）之间差异有统计学意义（P<0.05）。 结论 OCT影像与HE图像中形态学的一致性较好，OCT有望成为冠状动脉及心肌梗死组织法医病理学检验的初筛手段，对提高诊断准确率起到一定的辅助作用。

关键词: 法医病理学, 体层摄影术, 光学相干, 冠心病, 心肌梗死

Abstract: Objective To investigate the value of optical coherence tomography （OCT） in the diagnosis of coronary atherosclerosis and myocardial infarction in forensic identification. Methods OCT and hematoxylin-eosin （HE） examination were performed to examine the pathological samples of coronary artery and myocardial infarction in 5 cases of sudden coronary death. The morphological and local measurement indexes were compared. Results In the OCT images, the layers of coronary artery could be distinguishably featured, and the atheroma plaques had a good morphological correspondence with HE slices. The normal myocardia in the OCT image showed weak light signals with high absorbance, while the fiber scar tissues in the myocardial infarction areas showed strong light signals with low absorbance. There were no significant differences on the fibrous cap thickness in coronary atherosclerotic plaques or intima-media thickness between the OCT images and the HE slices （P>0.05）. In the OCT images, the optical densities of the old myocardial infarction areas （1 226.24±622.66） and those of normal myocardia （3 707.90±962.98） were significantly different （P<0.05）. Conclusion The OCT image has a good morphological consistency with HE slice, thus is expected to be the primary screening method for the forensic pathology examination of coronary artery atherosclerosis and myocardial infarction, which can help to improve the diagnostic accuracy.

Key words: forensic pathology, tomography, optical coherence, coronary artery disease, myocardial infarction