两例极重度骨髓型放射病肺组织病变的病理学对比观察及分析

Comparative observation and analysis of pulmonary pathological changes in two cases of extremely severe hematopoietic radiation sickness

目的对比观察不同吸收剂量、不同存活时间对极重度骨髓型放射病肺组织病变发生发展的影响。方法分别于病人死亡后从肺脏取材,每个尸检病例从不同部位取材数块,10%甲醛固定,石蜡包埋,病理组织切片,分别行HE和Gimsa染色,光学显微镜观察和分析。结果极重度骨髓型伴轻度肠型放射病尸检病例(107号)肺内主要病变为肺组织大面积坏死伴广泛性曲霉菌感染;另一极重度骨髓型放射病尸检病例(108号)肺内主要病变为广泛性卡氏肺孢子虫感染,虫体充满肺泡腔,肺泡间隔增宽,成纤维细胞活跃增生伴胶原纤维形成。结论放射病抢救治疗过程中肺内容易继发霉菌或卡氏肺孢子虫感染,可能与病人的呼吸衰竭和早期死亡有直接关系;极重度骨髓型放射病人的存活时间超过2个月,早期肺纤维化过程开始启动。

Objective To comparatively observe the effect of different irradiation doses and survival time on pulmonary pathological changes in extremely severe hematopoietic radiation sickness （ESHRS） . Method Samples were taken from different positions of lung tissues in each of the two dead victims, and were fixed by 10% formalin , and then embedded with paraffin. Slice and HE staining were performed, slides were observed under optical microscope and the pathological change was analysis. Results The predominant pathological changes included large areas of necrosis in lung tissue and concomitant extensive infection of aspergillus in the case of ESHRS with slight intestinal type of radiation sickness （No. 107） ; in another ESHRS case （No. 108）, the main pathological alterations included extensive infection of Pneumocystis carinii, filling of pulmonary alveoli with Pneumocystis carinii, thickening of alveolar septum, active proliferation of fibroblast and concomitant formation of collagen fibers. Conclusion Secondary infection of aspergillus or Pneumocystis carinii in lung tissues during the process of rescue and treatment of radiation sickness is directly related to patient＇s respiratory failure and early death. Pulmonary early fibrosis process can be initiated after ESHRS victim survive for more than two months.