重症甲型H1N1流感八例呼吸系统病理学特征分析
중증갑형H1N1류감팔례호흡계통병이학특정분석
Pulmonary pathology in fatal human influenza A (H1N1) infection
  • 万方数据
    中华病理学杂志 중화병이학잡지
    Chinese Journal of Pathology
    2011年 12期 825-829 ,共5页

    段雪晶%李勇%宫恩聪%王珏%吕福东%张贺秋%孙琳%岳竹君%宋晨朝%张世杰%李宁%戴洁

    단설정%리용%궁은총%왕각%려복동%장하추%손림%악죽군%송신조%장세걸%리저%대길

    流感病毒A型,H1N1亚型%肺炎,病毒性%肺泡%尸体解剖 流感病毒A型,H1N1亞型%肺炎,病毒性%肺泡%尸體解剖
    류감병독A형,H1N1아형%폐염,병독성%폐포%시체해부
    Influenza A virus,H1N1 subtype%Pneumonia,viral%Pulmonary alveoli%Autopsy
    目的 探讨重症甲型H1N1流感死亡患者呼吸系统病理变化特征.方法 收集北京市8例重症甲型H1N1流感死亡病例,其中6例为死后床旁穿刺标本,2例为系统尸体解剖标本,进行常规病理形态学观察,并利用免疫组织化学、流式细胞术、Western blot等技术进行病毒定位检测.结果 重症甲型H1N1流感患者呼吸系统的主要病理改变为坏死性支气管炎伴周围炎、弥漫性肺泡损伤、肺出血.Westem blot检测肺组织内可见病毒抗原的表达,免疫组织化学染色显示甲型H1N1病毒核蛋白、血凝素抗原主要表达于部分气管、细支气管上皮及腺体、肺泡上皮细胞、巨噬细胞、血管内皮细胞等.流式细胞术检测2例尸体解剖病例肺内Ⅱ型肺泡上皮凋亡率(32.15％,78.15％)明显高于对照组(1.93％,3.77％).结论 弥漫性肺泡损伤、肺出血和晚期的肺纤维化是甲型H1N1流感重症死亡的主要病理改变；肺脏的损伤可能与病毒侵袭有关.
    목적 탐토중증갑형H1N1류감사망환자호흡계통병리변화특정.방법 수집북경시8례중증갑형H1N1류감사망병례,기중6례위사후상방천자표본,2례위계통시체해부표본,진행상규병리형태학관찰,병이용면역조직화학、류식세포술、Western blot등기술진행병독정위검측.결과 중증갑형H1N1류감환자호흡계통적주요병리개변위배사성지기관염반주위염、미만성폐포손상、폐출혈.Westem blot검측폐조직내가견병독항원적표체,면역조직화학염색현시갑형H1N1병독핵단백、혈응소항원주요표체우부분기관、세지기관상피급선체、폐포상피세포、거서세포、혈관내피세포등.류식세포술검측2례시체해부병례폐내Ⅱ형폐포상피조망솔(32.15％,78.15％)명현고우대조조(1.93％,3.77％).결론 미만성폐포손상、폐출혈화만기적폐섬유화시갑형H1N1류감중증사망적주요병리개변；폐장적손상가능여병독침습유관.
    Objective To study the pulmonary pathology in patients died of fatal human influenza A(H1N1) infection.Methods Eight cases of fatal human influenza A (H1N1) infection,including 2 autopsy cases and 6 paramortem needle puncture biopsies,were enrolled into the study.Histologic examination,immunohistochemitry,flow cytometry and Western blotting were carried out.Results The major pathologic changes included necrotizing bronchiolitis with surrounding inflammation,diffuse alveolar damage and pulmonary hemorrhage.Influenza viral antigen expression was detected in the lung tisue by Western blotting. Immunohistochemical study demonstrated the presence of nuclear protein and hemagglutinin virus antigens in parts of trachea,bronchial epithelium and glands,alveolar epithelium,macrophages and endothelium.Flow cytometry showed that the apoptotic rate of type Ⅱ pneumocytes (32.15％,78.15％ ) was significantly higher than that of the controls ( 1.93％,3.77％ ).Conclusion Necrotizing bronchiolitis,diffuse alveolar damage and pulmonary hemorrhage followed by pulmonary fibrosis in late stage are the major pathologic changes in fatal human influenza A (H1N1) infection.
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