儿童特发性血小板减少性紫癜脾脏组织的病理形态学研究

Histopathological Study on Spleen With Idiopathic Thrombocytopenic Purpura in Childhood

目的通过研究儿童特发性血小板减少性紫癜(ITP)的脾脏病理学改变,探讨小儿ITP脾脏的病理组织学特点及其在发病中的作用。方法光镜观察39例儿童ITP脾脏组织病理形态学变化并对白髓组织进行形态测量,部分病例作了电镜超微结构检查,并与28例对照组脾脏进行比较分析。结果39例儿童ITP中,有11例(28.2%)在白髓组织内出现明显的次级淋巴滤泡增生现象,而对照组为16例(57.1%);白髓平均面积ITP组较对照组减少,而每mm2白髓数目较对照组略有增多,粒细胞浸润及泡沫细胞增生现象在ITP组均较对照组明显。超微结构显示ITP脾脏中单核巨噬细胞系统功能活跃,巨噬细胞及中性粒细胞均有吞噬现象。结论ITP脾脏病理学改变缺乏特异性,但仍有一定的特点,主要是吞噬细胞系统的功能活跃,包括巨噬细胞及粒细胞均有明显的增多并表现有活跃的吞噬现象;脾切术前的糖皮质激素治疗可能对白髓内淋巴组织的增生有一定的抑制作用;病理学改变的个体差异可能与ITP脾切除术后的疗效之间存在一定的关系。

Objective To study the pathological changes of spleen affected with idiopathic thrombocytopenic purpura （ITP）,in order to clarify histopathological characteristics of children＇s ITP spleen and its role in ITP pathogenesis. Methods 39 cases of ITP histopathological morphology changes were observed,and the white pulp tissues were morphometrically measured,partical cases were examined using electron micrography. Final obtained data was compared with 28 cases control spleen. Results The prominent secondary follicles presented in 11 （28.2%） of 39 ITP cases, but only 16 （57.1%） in control cases.As compared with control cases, the average area of white pulp in ITP cases was decreased but the pulp number per mm2 was slightly increased. Granulocyte infitration and foamy cells hyperplasia were prominent in ITP spleens. The electron microscope showed action enhancement for phagocytosis of mononuclear macrophages and granulocytes in ITP spleen. Conclusions Although no special morphologic structures were found, the structure of ITP spleen still have some charac- teristics, such as active phagocytosis, increasing granulocyte and foamy macrophage etc. The morphologic changes of lymphoproliferation in white pulp of ITP spleen may be alleviated by corticosteroid therapy before splenectomy. The individual difference of pathologic changes in ITP spleens may relative to the efficacy after splenectomy.