中华结核和呼吸杂志
中華結覈和呼吸雜誌
중화결핵화호흡잡지
Chinese Journal of Tuberculosis and Respiratory Diseases
2012年
12期
887-891
,共5页
罗本芳%李惠萍%易祥华%陶巨蔚%吕寒静%方霞%张宗梅%张龙%任胜祥%褚海青%李霞%曾郁
囉本芳%李惠萍%易祥華%陶巨蔚%呂寒靜%方霞%張宗梅%張龍%任勝祥%褚海青%李霞%曾鬱
라본방%리혜평%역상화%도거위%려한정%방하%장종매%장룡%임성상%저해청%리하%증욱
肺泡蛋白沉积症%痰%支气管肺泡灌洗液%显微镜检查,电子,透射
肺泡蛋白沉積癥%痰%支氣管肺泡灌洗液%顯微鏡檢查,電子,透射
폐포단백침적증%담%지기관폐포관세액%현미경검사,전자,투사
Pulmonary alveolar proteinosis%Sputum%Bronchoalveolar lavage fluid%Microscopy,electron,transmission
目的 探讨肺泡蛋白沉积症(PAP)患者痰液沉淀物(SD)的超微结构特点及其诊断价值.方法 选择同济大学附属上海市肺科医院和同济大学附属同济医院2000年1月至2009年12月间经肺活检和细胞学病理诊断的PAP患者7例(PAP组),其中男5例,女2例,中位年龄48岁(36～73岁)；将SD和BALF离心沉淀物分别制作超薄切片,透射电镜比较观察.同期选取具有双肺浸润性病变(细菌性肺炎3例,COPD和浸润性肺结核各2例)患者7例(对照组),其中男4例,女3例,中位年龄49岁(39～68岁)；每例SD制作超薄切片,与PAP组透射电镜观察结果比较分析.结果 PAP组7例患者中痰直接涂片淀粉酶消化后过碘酸雪夫染色未检出有诊断意义的细胞成分；BALF沉淀物石蜡包埋切片细胞学光镜观察,4例符合PAP.BALF透射电镜观察,肺泡上皮细胞内以及细胞外有大量同心圆状的板层小体,5例符合PAP诊断.SD的透射电镜观察,巨噬细胞胞质内有较多髓鞘样的吞噬体,肺泡上皮细胞内有较多的板层小体,细胞外有较多同心圆状的板层小体,细胞和板层小体明显退变,4例符合PAP诊断,SD和BALF比较在电镜诊断PAP上差异无统计学意义(x2=1.000,P ＞0.05).对照组7例中均未检出细胞外游离的嗜锇板层小体.结论 PAP患者SD和BALF样本中均可检出具有诊断意义的嗜锇板层小体,结合临床和影像学可以对PAP作出明确的诊断,尤其对于肺活检和肺泡灌洗有禁忌证的患者,是协助诊断PAP的一个重要方法.
目的 探討肺泡蛋白沉積癥(PAP)患者痰液沉澱物(SD)的超微結構特點及其診斷價值.方法 選擇同濟大學附屬上海市肺科醫院和同濟大學附屬同濟醫院2000年1月至2009年12月間經肺活檢和細胞學病理診斷的PAP患者7例(PAP組),其中男5例,女2例,中位年齡48歲(36～73歲)；將SD和BALF離心沉澱物分彆製作超薄切片,透射電鏡比較觀察.同期選取具有雙肺浸潤性病變(細菌性肺炎3例,COPD和浸潤性肺結覈各2例)患者7例(對照組),其中男4例,女3例,中位年齡49歲(39～68歲)；每例SD製作超薄切片,與PAP組透射電鏡觀察結果比較分析.結果 PAP組7例患者中痰直接塗片澱粉酶消化後過碘痠雪伕染色未檢齣有診斷意義的細胞成分；BALF沉澱物石蠟包埋切片細胞學光鏡觀察,4例符閤PAP.BALF透射電鏡觀察,肺泡上皮細胞內以及細胞外有大量同心圓狀的闆層小體,5例符閤PAP診斷.SD的透射電鏡觀察,巨噬細胞胞質內有較多髓鞘樣的吞噬體,肺泡上皮細胞內有較多的闆層小體,細胞外有較多同心圓狀的闆層小體,細胞和闆層小體明顯退變,4例符閤PAP診斷,SD和BALF比較在電鏡診斷PAP上差異無統計學意義(x2=1.000,P ＞0.05).對照組7例中均未檢齣細胞外遊離的嗜鋨闆層小體.結論 PAP患者SD和BALF樣本中均可檢齣具有診斷意義的嗜鋨闆層小體,結閤臨床和影像學可以對PAP作齣明確的診斷,尤其對于肺活檢和肺泡灌洗有禁忌證的患者,是協助診斷PAP的一箇重要方法.
목적 탐토폐포단백침적증(PAP)환자담액침정물(SD)적초미결구특점급기진단개치.방법 선택동제대학부속상해시폐과의원화동제대학부속동제의원2000년1월지2009년12월간경폐활검화세포학병리진단적PAP환자7례(PAP조),기중남5례,녀2례,중위년령48세(36～73세)；장SD화BALF리심침정물분별제작초박절편,투사전경비교관찰.동기선취구유쌍폐침윤성병변(세균성폐염3례,COPD화침윤성폐결핵각2례)환자7례(대조조),기중남4례,녀3례,중위년령49세(39～68세)；매례SD제작초박절편,여PAP조투사전경관찰결과비교분석.결과 PAP조7례환자중담직접도편정분매소화후과전산설부염색미검출유진단의의적세포성분；BALF침정물석사포매절편세포학광경관찰,4례부합PAP.BALF투사전경관찰,폐포상피세포내이급세포외유대량동심원상적판층소체,5례부합PAP진단.SD적투사전경관찰,거서세포포질내유교다수초양적탄서체,폐포상피세포내유교다적판층소체,세포외유교다동심원상적판층소체,세포화판층소체명현퇴변,4례부합PAP진단,SD화BALF비교재전경진단PAP상차이무통계학의의(x2=1.000,P ＞0.05).대조조7례중균미검출세포외유리적기철판층소체.결론 PAP환자SD화BALF양본중균가검출구유진단의의적기철판층소체,결합림상화영상학가이대PAP작출명학적진단,우기대우폐활검화폐포관세유금기증적환자,시협조진단PAP적일개중요방법.
Objective To investigate the ultrastructural features of sputum deposition(SD) and its value in the diagnosis of pulmonary alveolar proteinosis (PAP).Methods Seven patients with PAP diagnosed by lung biopsy and cytology were enrolled in this study.The patients consisted of 5 men and 2 women,whose median age was 48 years (range 36 to 73).SD and bronchoalveolar lavage fluid(BALF)sediment were made into ultrathin sections and observed under transmission electron microscope (TEM),respectively.Seven cases of control group composed of 4 men and 3 women whose median age was 49 years (range 39 to 68) including 3 cases of bacterial pneumonia,two cases of COPD and 2 cases of exudative pulmonary tuberculosis.Each SD was made into ultrathin section,and compared with the experimental group.Results In PAP group,Periodic acid-schiff (PAS) staining was performed on 7 sputum smears and none of them was tested positive for any components with diagnostic interest.Four cases from the 7 paraffinembed sections of BALF sediment by microscopic examination suggested PAP.Under TEM,BALF sediment showed that many lamellar bodies existed in and outside alveolar epithelial cells,and 5 specimens were consistent with PAP diagnosis.Compared with BALF sediment,SD had apparent degeneration with more myelin phagosomes in the cytoplasm of macrophages,more lamellar bodies in alveolar epithelial cells,and lots of lamellar bodies in the shape of concentric circle in the extracellular spaces.Four from the 7 SD samples were consistent with the diagnosis of PAP.No significant difference was found between SD and BALF in the diagnosis of PAP by electronic examination (P ＞ 0.05).In the 7 cases of control group no drifting osmiophilic lamellar bodies in extracellular space were detected.Conclusions The osmiophilic lamellar bodies with diagnostic value were found in SD and BALF of patients with PAP.TEM of SD in combination with clinical manifestations and radiologic findings can make a definitive diagnosis of PAP,especially for those patients who have contraindications to lung biopsy and lung lavage.
