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目的探索新型甲型H1N1流感病毒感染重症死亡病例呼吸道及外周免疫器官病理形态学及免疫细胞的变化。方法收集2009年北京甲型H1N1流感重症死亡病例8例,其中2例为系统尸体解剖标本,6例为床旁穿刺标本,以手足口病1例作为对照。HE染色观察病理形态学变化;免疫组织化学技术检测肺、脾和淋巴结免疫细胞变化。结果实验组表现为坏死性支气管炎和周围炎,弥漫性肺损伤、肺出血、纤维化,巨噬细胞明显增生,淋巴细胞浸润不明显。甲型H1N1流感病毒血凝素和核蛋白抗原主要表达于呼吸道上皮及巨噬细胞。免疫细胞计数:CD68+巨噬细胞显著增多,CD20+B淋巴细胞、CD3+、CD4+、CD8+T细胞减少,CD56+细胞偶见,各类细胞与对照组比较差异无统计学意义。脾和淋巴结病变基本一致,灶状组织细胞增生,“噬红现象”明显,淋巴组织萎缩,残留滤泡内以滤泡树突状细胞(follicular dendritic cell,FDC)细胞为主。免疫细胞计数:CD68+巨噬细胞显著增多,但与对照组比较差异无统计学意义(P>0.05);CD20+B淋巴细胞、CD3+、CD4+、CD8+T免疫细胞数明显低于对照组(P<0.05);CD4+和CD8+T淋巴细胞的比值与对照组相比,差异无统计学意义;CD56+细胞在脾脏明显低于对照组,淋巴结内两组均偶见。结论新型甲型H1N1流感重症患者外周免疫器官明显萎缩,特异性免疫功能减弱,其中细胞免疫反应下降更明显。
Objective To explore the pathological changes of respiratory tract and peripheral immune organs and the changes of immune cells in severe deaths caused by new type A (H1N1) virus. Methods Eight cases of serious deaths from Influenza A (H1N1) in Beijing in 2009 were collected, including 2 cases of systematic autopsy specimens and 6 cases of bedside puncture specimens. One case of HFMD was used as a control. Pathological changes were observed by HE staining. Immunocytochemistry was used to detect the changes of immune cells in lung, spleen and lymph nodes. Results The experimental group showed necrotizing bronchitis and peripheral inflammation, diffuse lung injury, pulmonary hemorrhage, fibrosis, hyperplasia of macrophages and infiltration of lymphocytes. Influenza A (H1N1) virus hemagglutinin and nucleoprotein antigens are mainly expressed in the respiratory epithelium and macrophages. Immune cell count: CD68 + macrophages increased significantly, CD20 + B lymphocytes, CD3 +, CD4 +, CD8 + T cells decreased, CD56 + cells occasionally, all kinds of cells compared with the control group no significant difference. The pathological changes of spleen and lymph node were basically the same, the proliferation of focal tissue cells, the obvious reddening of the lymphoid tissue and the shrinkage of lymphatic tissue. The majority of follicular dendritic cells (FDC) were the residual follicles. The numbers of CD20 + B lymphocytes, CD3 +, CD4 + and CD8 + T cells in immune cells were significantly higher than those in control group (P <0.05) <0.05). There was no significant difference in the ratio of CD4 + and CD8 + T lymphocytes compared with the control group. CD56 + cells in the spleen were significantly lower than those in the control group. Conclusion The peripheral immune organs of patients with new type A (H1N1) flu significantly shrunk and the specific immune function weakened. The cellular immune response decreased more obviously.