人感染高致病性禽流感病毒H5N1尸体解剖病理分析

Pathologic changes caused by highly pathogenic H5N1 avian influenza virus:postmortem study of a case

目的探讨人感染禽流感死亡病例尸体解剖组织的病理学特征。方法尸体解剖1例人感染 H5N1高致病性禽流感病毒死亡病例,对其心、肺、肝、脾、肾和大脑等组织进行光镜观察,对肺组织进行了组织化学和免疫组织化学表型以及电镜观察。结果人感染禽流感的主要病变为双肺弥漫性肺泡损伤,透明膜形成,以及多灶性出血。肺泡腔内充满淡红粉染物(即水肿液)和不等量的各种炎细胞,炎细胞以淋巴细胞、单核细胞、浆细胞和少许中性粒细胞以及吞噬细胞为主。肺泡壁血管广泛性扩张淤血,部分肺泡壁透明膜形成。免疫组织化学染色显示:炎细胞主要以 T 淋巴细胞和单核细胞为主。结论人感染禽流感病理形态学改变以肺部最明显,主要为双肺弥漫性肺泡损伤,急性弥漫性渗出性病变,渗出的细胞以 T 淋巴细胞和单核细胞为主。肺部广泛性实变、肺水肿、肺出血导致呼吸窘迫是本病的主要死因。

Objective To report the postmortem findings of a case of highly pathogenic H5N1 avian influenza virus occurring in human beings. Methods Postmortem examination was carried out in a deceased caused by highly pathogenic H5N1 avian influenza virus. Detailed light microscopy of major organs, including heart, lungs, liver, spleen, kidneys and brain, was performed. The lung tissue was further investigated by histochemistry, immunohistochemistry and electron microscopy. Results Major histopathologic changes in lungs secondary to highly pathogenic H5N1 avian influenza virus included diffuse alveolar damage, hyaline membrane formation and focal hemorrhage. Some of the alveolar spaces contained lightly eosinophilic liquid, lymphocytes, macrophages, plasma ceils and small number of neutrophils. Congested capillaries were commonly seen in the alveolar septa which were focally rimmed by hyaline membrane. Immunohistochemical study showed that the lymphocytes were mainly of T lineage and macrophages were also demonstrated. Conclusions Highly pathogenic H5N1 avian influenza virus causes pathologic changes mostly in lungs, including diffuse alveolar damage and acute exudative changes （involving mainly T lymphocytes and macrophages）. The resulting parenchymal destruction, consolidation, pulmonary edema and hemorrhage eventually lead to respiratory distress and death.