新甲型H1N1流感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

doi:10.3969/j.issn.1006-7795.2015.05.019

首都医科大学学报 ›› 2015, Vol. 36 ›› Issue (5): 761-767.doi: 10.3969/j.issn.1006-7795.2015.05.019

新甲型H1N1流感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

齐晶¹, 吕福东², 段雪晶³, 王珏¹, 王大业¹, 徐鑫¹, 白云飞¹, 李宏军², 金荣华², 李宁², 戴洁¹

1. 首都医科大学基础医学院病理学系, 北京 100069;
2. 首都医科大学附属北京佑安医院, 北京 100069;
3. 中国医学科学院北京协和医学院国家重点实验室阜外心血管病医院病理科, 北京 100037

收稿日期:2015-03-20 出版日期:2015-10-21 发布日期:2015-10-20
基金资助:
首都医学科技发展基金资助(2009-2091)。

Pathological morphology change of respiratory and peripheral immune organ and the change of immune cells

Qi Jing¹, Lyu Fudong², Duan Xuejing³, Wang Jue¹, Wang Daye¹, Xu Xin¹, Bai Yunfei¹, Li Hongjun², Jin Ronghua², Li Ning², Dai Jie¹

1. Department of Pathology, School of Basic Medical Sciences, Capital Medical University, Beijing 100069, China;
2. Beijing Youan Hospital, Capital Medical University, Beijing 100069, China;
3. Chinese Academy of Medical Sciences, Beijing Union Medical College, State Key Laboratory, Department of Pathology, Fuwai Cardiovascular Disease Hospital, Beijing 100037, China

Received:2015-03-20 Online:2015-10-21 Published:2015-10-20
Contact: 戴洁 E-mail:sydaijie@ccmu.edu.cn
Supported by:
This study was supported by the Capital Medical Science Development Foundation of China (2009-2091).

摘要/Abstract

摘要： 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。

关键词: 新型甲型H1N1, 尸检, 免疫器官, 免疫细胞

Abstract: Objective To explore the pathology morphological changes of trachea and peripheral immune organ and immune cells of the new influenza A (H1N1) virus severe infection. Methods To collect Collection of 2009 Beijing influenza A H1N1 intensive deaths 8 cases; Pathological changes of these tissue were observed by HE staining; The immune cell types were tested, quantity and distribution characteristics were made by immunohistochemistry. Results The principal pathologic changes of trachea were necrotizing bronchiolitis with peripheral inflammation, diffuse alveolar damage, pulmonary hemorrhage and fibrosis. Macrophages hyperplasia and little lymphocyte infiltration; Viral antigen was found in the epithelium of the epithelium and macrophage; CD68⁺ macrophage count significantly increased in lung, CD20⁺ B lymphocytes, CD3⁺, CD4⁺, CD8⁺ T count, CD56⁺ NK cells occasional,no obvious differences were found compared with the control group (P>0.05). Spleen and lymph nodes were same,focal histocyte hyperplasia, erythrocytophagy were observed, lymphoid tissue atrophy.IHC cell count showed CD68⁺ macrophage significantly increased, CD20⁺ B, CD3⁺, CD4⁺, CD8⁺ T lymphocytes were significantly lower than the control group (P<0.05). NK cells were rarely seen in the spleen and lymph nodes. The ratio of CD4⁺ and CD8⁺ T lymphocytes between experimental group and control group is not significant different. Conclusion The severe influenza A (H1N1) patients, peripheral immune organs showed significant atrophy, specific immune function was abated and the cellular immune response decreased more significantly.

Key words: the new influenza A(H1N1), autopsy, immune organs, immune cells

中图分类号:

齐晶, 吕福东, 段雪晶, 王珏, 王大业, 徐鑫, 白云飞, 李宏军, 金荣华, 李宁, 戴洁. 新甲型H1N1流感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[J]. 首都医科大学学报, 2015, 36(5): 761-767.

Qi Jing, Lyu Fudong, Duan Xuejing, Wang Jue, Wang Daye, Xu Xin, Bai Yunfei, Li Hongjun, Jin Ronghua, Li Ning, Dai Jie. Pathological morphology change of respiratory and peripheral immune organ and the change of immune cells[J]. Journal of Capital Medical University, 2015, 36(5): 761-767.

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新甲型H1N1流感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

Pathological morphology change of respiratory and peripheral immune organ and the change of immune cells

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