点击显示 收起
年轻人猝死经常被归咎于古柯碱或者美沙酮滥用， 但是一项新研究显示，这些死亡多半是自然原因所致。
阿拉巴马大学病理科住院医师Zhaohai Yang在美国临床病理学会(ASCP) 2007年会的海报展示中报告指出，许多年轻人的死亡被认为与药物有关—特别是曾有药物滥用者又没有进行切片验证时。
Yang 医师向Medscape病理学表示，该研究目的在了解年轻人无法解释的猝死，我们发现至少有半数与药物无关。
这个3年的切片案例研究，以解剖检视没有明显疾病或意外、非创伤猝死之年轻人(年纪≦40岁)的死因。
研究者指出，根据2007年3月的全国死亡统计报告，15至44岁者的首要死因是意外事件，占所有死亡的19%到49%；本系列研究中回顾了781件案例，有22例 (17位男性以及5位女性，年纪14至40岁)适合研究规范。
这22个案例中，45%死于药物中毒，55%死于自然原因，其中冠状动脉疾病占27%的心脏相关死亡，其他73%的心脏相关死亡为先天心脏异常、传导系统疾病、轻微心脏构造异常。
有10例死亡(45%) 筛检出违法药物阳性，药物中毒被视为是主要死因，其他12例(55%)进行解剖鉴定。
心脏病是最多的死因，有11例死亡 (50%)，3例冠状动脉疾病/急性心肌梗塞死亡，5例心肌纤维化/心脏肥大合并疑似气喘，1例心肌病变(心脏大规模类肉瘤病)，2例天先心脏异常(1 例死于二尖主动脉瓣而缺少左回旋冠状动脉，1例死于房室结动脉发育不全)；另有1位病患死于肺栓塞。
Yang医师和同样来自阿拉巴马大学的资深作者Stephanie D. Reilly医师在摘要中指出，有8例曾有药物滥用史，其中6例死于药物中毒，但有2 位筛检出来是阴性而死于自然原因，即使是有药物滥用史的病患，仍有一部分是死于意料之外的医疗状况；此外，4 位没有药物滥用史的病患出现药物相关死亡。.
Reilly医师向Medscape病理学表示，这意味阴性药物史者无法将药物中毒排除于可能死因之外。
研究者在海报中指出，检验的药物中，已知古柯碱和diazepam有心脏毒性，美沙酮影响QTc 间隔，死于药物滥用者有侦测出轻微心脏异常；不过，不清楚是否有加成效果。
ASCP理事长、加州大学David Geffen医学院病理与实验室医学教授Lee Hilborne医师在Medscape病理学访谈中表示，切片的价值之一是可以辨识死因和相关医疗发现，将对往生者的家属有帮助。
他表示，虽然死于未检测之医疗问题的死因略超过半数，剩下的是与药物相关—但你不可以忽略这些药物有直接的不良并发症。
该研究未接受外来资金，作者们和Hilborne医师宣称无相关财经关系。
美国临床病理学会 2007年会：摘要 88。于2007年10月20日发表。
Sudden Unexpected Death in Young Adults Often Due to Natural Causes
By Carole Bullock, MA
Medscape Medical News
Sudden unexpected death among young adults is often blamed on cocaine or methadone abuse, but a new study shows that more than half of these deaths are the result of natural causes.
"Many of the deaths in younger people are assumed to be drug-related — especially when there is a history of drug use and an autopsy is not performed," Zhaohai Yang, MD, a resident in the Department of Pathology, University of Alabama at Birmingham, reported at a poster session here at the American Society for Clinical Pathology (ASCP) 2007 Annual Meeting.
"The study was conducted to understand the causes of sudden unexplained death among young adults, and we found that at least half were not drug related," Dr. Yang told Medscape Pathology.
The 3-year autopsy case study identified anatomic causes of death in young individuals (aged ≤40 years) without known significant medical disease who suffered unexpected, nontraumatic sudden death.
According to the National Vital Statistic Reports published in March 2007, accident is the leading cause of death in individuals aged 15 to 44 years, accounting for 19% to 49% of total deaths, the researchers reported. Of 781 cases reviewed in this series, 22 cases (17 men and 5 women aged 14 – 40 years) fit the study criteria.
Of the 22 cases, 45% died of drug intoxication, and 55% died of natural causes. Although coronary artery disease accounted for 27% of heart-related deaths, congenital cardiac anomalies, disease involving the conduction system, and mild structural cardiac abnormalities were the major findings in 73% of the heart-related deaths.
Ten deaths (45%) in the series had a positive drug screen for illegal drugs, and drug toxicity was considered to be the major cause of death. Anatomic causes were identified in the remaining 12 cases (55%).
Heart disease was the number one cause of death, accounting for 11 deaths (50%). There were 3 coronary artery disease/acute myocardial infarction deaths, 5 myocardial fibrosis/cardiomegaly with presumed arrhythmia deaths, 1 cardiomyopathy death (systemic sarcoidosis with extensive involvement of the heart), and 2 congenital heart disease deaths (1 death from bicuspid aortic valve and absence of left circumflex coronary artery, and 1 from dysplasia of the atrioventricular nodal artery).
One person died of a pulmonary thromboembolism.
"Of note, a positive drug history was reported in 8 cases; 6 of these individuals died of drug intoxication, but 2 had negative drug screens and died of natural causes," Dr. Yang and senior author Stephanie D. Reilly, MD, also from the Univerity of Alabama, write in their abstract. "Even in patients with a drug abuse history, a significant portion of cases had an unsuspected medical condition as the cause of death."
In addition, 4 patients who had a negative drug history had a drug-related death.
"This means that a negative drug history does not exclude drug toxicity as a possible cause of death," Dr. Reilly, told Medscape Pathology.
"Among the drugs detected, cocaine and diazepam are well-known to have cardiac toxicity, while methadone affects the QTc interval," the researchers note in the poster. "Mild heart abnormalities were detected in those who died of drug abuse; however, whether they had an additive effect is unknown."
ASCP President Lee Hilborne, MD, professor of pathology and laboratory medicine at the David Geffen School of Medicine at the University of California, Los Angeles, said in an interview with Medscape Pathology that "One of the values of the autopsy is that it can identify cause of death and reveal medical findings that may not have been appreciated in the person's life and may help the families."
Even though slightly more than half of the deaths were the result of undetected medical problems, he said, "the rest were drug-related — you can't ignore that these drugs had direct adverse consequences."
The study did not receive external funding. The authors and Dr. Hilborne have disclosed no relevant financial relationships.
American Society for Clinical Pathology 2007 Annual Meeting: Abstract 88. Presented October 20, 2007.