中华病理学杂志
中華病理學雜誌
중화병이학잡지
Chinese Journal of Pathology
2009年
2期
81-85
,共5页
陆敏%孟刚%何耀鑫%郑杰%廖松林%钟延丰%赵希顺%邵宏权%王玉萍%高占成%高子芬
陸敏%孟剛%何耀鑫%鄭傑%廖鬆林%鐘延豐%趙希順%邵宏權%王玉萍%高佔成%高子芬
륙민%맹강%하요흠%정걸%료송림%종연봉%조희순%소굉권%왕옥평%고점성%고자분
肠道病毒感染%尸体解剖%中枢神经系统病毒感染
腸道病毒感染%尸體解剖%中樞神經繫統病毒感染
장도병독감염%시체해부%중추신경계통병독감염
Enterovirus infections%Autopsy%Central nervous system viral diseases
目的 探讨感染肠道病毒71型(EV71)重症婴幼儿的临床病理特点.方法 对5例死亡患者尸体系统解剖,获得脑、肠、心、肝、脾、肺、肾、胰腺和淋巴结等脏器,组织常规HE染色,3例行免疫组织化学EnVision法以标记脑和肺组织细胞,光镜下观察.结果 4例中枢神经系统病变明显,即以脑干和颈髓上段为主的多部位脑炎和脊髓炎,表现为神经元变性和坏死、噬神经现象、血管套、脑实质内单核巨噬细胞/小胶质细胞弥漫或结节状增生,伴少量淋巴细胞浸润;脑水肿伴小脑扁桃体疝形成;有脑膜炎和脊膜炎病变;呼吸系统表现为肺淤血和不同程度的神经源性肺水肿及肺出血;消化系统黏膜上皮未见病变,回肠末端黏膜固有层和黏膜下层内淋巴组织增生显著,淋巴滤泡内细胞凋亡严重.另1例中枢神经系统仪见脑水肿伴轻度脑膜炎;呼吸系统见肺泡间隔增宽伴淋巴、单核细胞浸润,部分肺泡上皮增生,广泛肺透明膜形成;消化系统肠黏膜未见明显病变,肠黏膜固有层内淋巴组织增生.5例淋巴造血系统表现为肺门淋巴结和肠系膜淋巴结肿大,其内淋巴滤泡扩大,但生发中心凋亡明显,伴有不同程度的中性粒细胞浸润.脾脏脾小结内各类细胞减少.5例心脏、肝脏和肾脏组织学上均无明显病变.结论 感染EV71重症病例的病变主要累及中枢神经系统,呼吸系统为继发性病变,此类患儿主要因脑水肿致脑疝形成或肺水肿致呼吸循环衰竭死亡.个别病例主要表现为呼吸系统病变,中枢神经系统病变不典型.
目的 探討感染腸道病毒71型(EV71)重癥嬰幼兒的臨床病理特點.方法 對5例死亡患者尸體繫統解剖,穫得腦、腸、心、肝、脾、肺、腎、胰腺和淋巴結等髒器,組織常規HE染色,3例行免疫組織化學EnVision法以標記腦和肺組織細胞,光鏡下觀察.結果 4例中樞神經繫統病變明顯,即以腦榦和頸髓上段為主的多部位腦炎和脊髓炎,錶現為神經元變性和壞死、噬神經現象、血管套、腦實質內單覈巨噬細胞/小膠質細胞瀰漫或結節狀增生,伴少量淋巴細胞浸潤;腦水腫伴小腦扁桃體疝形成;有腦膜炎和脊膜炎病變;呼吸繫統錶現為肺淤血和不同程度的神經源性肺水腫及肺齣血;消化繫統黏膜上皮未見病變,迴腸末耑黏膜固有層和黏膜下層內淋巴組織增生顯著,淋巴濾泡內細胞凋亡嚴重.另1例中樞神經繫統儀見腦水腫伴輕度腦膜炎;呼吸繫統見肺泡間隔增寬伴淋巴、單覈細胞浸潤,部分肺泡上皮增生,廣汎肺透明膜形成;消化繫統腸黏膜未見明顯病變,腸黏膜固有層內淋巴組織增生.5例淋巴造血繫統錶現為肺門淋巴結和腸繫膜淋巴結腫大,其內淋巴濾泡擴大,但生髮中心凋亡明顯,伴有不同程度的中性粒細胞浸潤.脾髒脾小結內各類細胞減少.5例心髒、肝髒和腎髒組織學上均無明顯病變.結論 感染EV71重癥病例的病變主要纍及中樞神經繫統,呼吸繫統為繼髮性病變,此類患兒主要因腦水腫緻腦疝形成或肺水腫緻呼吸循環衰竭死亡.箇彆病例主要錶現為呼吸繫統病變,中樞神經繫統病變不典型.
목적 탐토감염장도병독71형(EV71)중증영유인적림상병리특점.방법 대5례사망환자시체계통해부,획득뇌、장、심、간、비、폐、신、이선화림파결등장기,조직상규HE염색,3례행면역조직화학EnVision법이표기뇌화폐조직세포,광경하관찰.결과 4례중추신경계통병변명현,즉이뇌간화경수상단위주적다부위뇌염화척수염,표현위신경원변성화배사、서신경현상、혈관투、뇌실질내단핵거서세포/소효질세포미만혹결절상증생,반소량림파세포침윤;뇌수종반소뇌편도체산형성;유뇌막염화척막염병변;호흡계통표현위폐어혈화불동정도적신경원성폐수종급폐출혈;소화계통점막상피미견병변,회장말단점막고유층화점막하층내림파조직증생현저,림파려포내세포조망엄중.령1례중추신경계통의견뇌수종반경도뇌막염;호흡계통견폐포간격증관반림파、단핵세포침윤,부분폐포상피증생,엄범폐투명막형성;소화계통장점막미견명현병변,장점막고유층내림파조직증생.5례림파조혈계통표현위폐문림파결화장계막림파결종대,기내림파려포확대,단생발중심조망명현,반유불동정도적중성립세포침윤.비장비소결내각류세포감소.5례심장、간장화신장조직학상균무명현병변.결론 감염EV71중증병례적병변주요루급중추신경계통,호흡계통위계발성병변,차류환인주요인뇌수종치뇌산형성혹폐수종치호흡순배쇠갈사망.개별병례주요표현위호흡계통병변,중추신경계통병변불전형.
Objective To study the clinicopathologic features of fatal enterovirus 71(EV71)infection.Methods Autopsy was performed in 5 neonates died of EV71 infection.Tissue samples from major organs were collected,formalin-fixed and examined under light microscopy.immunohistoehemical study was carried out in selected examples.Results Four of the 5 cases showed predominant changes in central nervous system,with encephalitis and encephalomyelitis identified maiuly in brainstem and upper cervical spinal cord.Histologic findings included neuronal degeneration and necrosis,neuronophagia, pefivascular cuffing and diffuse or nodular hyperplasia of macrophages/microglia.Cerebral edema,brain herniation and aseptic meningitis were also noted.The lungs showed mainly pulmonary congestion,neurogenie pulmonary edema and focal hemorrhage.There were minimal changes in the intestinal epithelium.The intestinal lymphoid tissue however Wag hyperplastie and agsociated with apoptosis of follicular center cells.The remaining cage had cerebral edema and mild meningitis.The lung alveolar septa Were thickened with lymphocytic infiltrates.Some alveolar cells were hyperplastie and associated with diffuse hyaline membrane formation.No specific abnormalities were identified in gastrointestinal tract. In all the 5 cat.s studied.there was enlargement of lung hilar and mesenteric lymph nodes,coupled With apoptosis of follicular center cells.In general,no significant pathologic changes were demonstrated in heart,liver and kidneys.Conclusions In fatal EV71 infection,the major pathologic changes lie in the central nervous svstem.The pulmonary lesions are mainly secondary in nature.The usual cause of death is cerebral edema complicated by brain herniation and pulmonary edema.It is also noteworthy that some cases show only lung damages,without classic neurologic changes.
