FORENSIC MEDICAL CRITERIA FOR DIFFERENTIAL DIAGNOSIS OF SUDDEN DEATH IN ALCOHOLIC CARDIOMYOPATHY AND ISCHEMIC HEART DISEASE

Background: Cardiovascular diseases remain a leading cause of mortality globally, with alcoholic cardiomyopathy (ACM) representing a significant but often under-diagnosed challenge in forensic practice. Objective: To improve differential diagnostic criteria for sudden death caused by ACM and ischemic heart disease (IHD) using complex post-mortem analysis, including morphological, biochemical, and histological methods. Methods: A retrospective analysis of forensic reports (2015–2020) and a prospective study of 196 cases were conducted. The subjects were divided into three groups: ACM (n=93), IHD (n=33), and a control group (n=35). Techniques included quantitative morphometry of the heart, blood ethanol chemical analysis, and biochemical screening. Results: Significant differences were found in heart mass (IHD: 494.82 g vs. ACM: 392.78 g) and coronary artery stenosis (IHD: 66% vs. ACM: 15%). Histological findings showed uneven blood filling and dystrophic changes in 94-95% of ACM cases compared to 52-64% in IHD. Blood ethanol levels in ACM cases averaged 2.75‰. Conclusion: The integration of biochemical markers and precise morphometric data provides a diagnostic reliability of over 90% in distinguishing ACM from other cardiac pathologies.背景：心血管疾病仍是全球范围内的首要致死病因，而酒精性心肌病（alcoholic cardiomyopathy, ACM）是法医实践中一类重要却常被漏诊的诊疗难题。 目的：本研究旨在借助形态学、生物化学及组织学等多元复杂死后分析技术，完善酒精性心肌病与缺血性心脏病（ischemic heart disease, IHD）所致猝死的鉴别诊断标准。 方法：本研究开展了2015年至2020年法医鉴定报告的回顾性分析，并对196例病例实施前瞻性研究。将研究对象划分为三组：酒精性心肌病组（n=93）、缺血性心脏病组（n=33）及对照组（n=35）。所用检测技术包括心脏定量形态计量分析、血液乙醇化学检测及生化筛查。 结果：研究发现两组在心脏重量（缺血性心脏病组：494.82g vs 酒精性心肌病组：392.78g）与冠状动脉狭窄程度（缺血性心脏病组：66% vs 酒精性心肌病组：15%）上存在显著统计学差异。组织学检测结果显示，94%~95%的酒精性心肌病病例存在血液充盈不均及营养不良性改变，而缺血性心脏病组的该比例仅为52%~64%。酒精性心肌病病例的血液乙醇平均浓度为2.75‰。 结论：将生化标志物与精准形态计量学数据相结合，在区分酒精性心肌病与其他心脏病变时的诊断可靠性可达90%以上。