Objective To confirm the optimal tissue sampling location of current injury combined with the histopathological observation in specific parts of electrocution based on previous animal experiments. Methods Twenty-three human cases from the autopsy through the hand-to-foot circuit pathway were analyzed. Additional ten autopsy patients who died from traffic accidents and sudden cardiac attacks were used as the control group. All cases were extracted the soft tissues from the upper anterior wrist and medial malleolus to further observe and analysis the L/S axis ratio of the nuclei of the skeletal muscle cells (SkMCs) and artery smooth muscle cells (ASMCs). Results The age of the 23 eligible electrical deaths ranged from 19 to 59 years, including 19 cases were male and 4 cases were female. 3 cases were high-voltage 20 cases were low voltage. The occurrence rate of electric marks averaged 31.18% in all cases. The incidence of the classical arborizing pattern of fine branching was 36.4%, appearing on the pleura in 5 cases (22.7%). The nuclei of the SkMCs and ASMCs nuclei in the anterior wrist and medial malleolus within the electrical current pathway were obviously stretched, narrowed, and coalesced, presenting a nuclear polarization and arranging as line-like and moniliform patterns. The L/S axis ratio of those nuclei in the anterior wrist and medial malleolus were markedly increased as compared with the control group (p < 0.001). Through the ROC curve analysis, the critical diagnostic values of the L/S axis ratio of those nuclei were respectively 4.84 and 3.81. Conclusion These findings suggest that the soft tissues of the anterior wrist and/or the medial malleolus, as the narrowest parts of the limbs, could be used as the sites for tissue sampling and considered as necessary locations for histopathological examinations to determine the electrocution in medicolegal identification.%目的 在前期动物实验基础上,结合电击死人体尸检病理组织学观察,确定电击死鉴定最佳的组织取材部位.方法 选取23例明确"手-足路径"电击死者,明确死于交通事故颅脑损伤和冠心病猝死者各10例为对照组.所有案例提取双腕上前内侧、双踝上后部等部位软组织,观察并分析其骨骼肌(SkMCs)和动脉血管平滑肌细胞(ASMCs)的核轴比变化.结果23例电击死案例,年龄19~59岁,男性19例、女性4例;高压电击死3例,日用低压电击死20例;7例出现典型电流斑(31.18%);5例出现胸膜电击纹(22.7%).电击死组的前腕、内踝的SkMCs和ASMCs细胞核拉长、扭曲,呈波浪样、栅栏状排列,其核轴比与对照组相同部位比较,有显著性差异(P<0.001),而且ROC曲线分析,SkMCs和ASMCs的核轴比的诊断临界值为分别4.84、3.81.结论 在"手-足路径"电击死的最佳取材部位应为机体电流路径中最狭窄位置,即腕、踝部位,该部位SkMCs和ASMCs细胞核的极向性拉长、靠近呈串珠状或直线状排列,为最具特征性和诊断价值的电损伤形态学变化.
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