获得性免疫缺陷综合征的肺部病变(151例尸检材料病理学研究)

The pathological changes in the lung of the patients with the acquired immunodeficiency syndrome(AIDS):

目的：研究纽约ＭｏｕｎｔＳｉｎａｉ医学中心１５１例尸检材料的肺部病变，旨在概括艾滋病患者肺部病变的频谱及其病理特征。方法：所有病例均按常规解剖、取材，福尔马林固定，石蜡包埋，苏木素伊红染色。必要时作组织化学染色和免疫组化研究。结果：１３４例（８８．７％）具有明显的肺部病变。常见的感染包括：（１）巨细胞病毒（ＣＭＶ）感染（４０例），特征为间质性肺炎、巨细胞形成及核内包涵体；（２）分支杆菌病，包括ＭＡＩ感染（１１例）及结核病（１０例）；（３）肺念珠菌病（９例）、隐球菌病（７例）、曲霉菌病（６例）等，表现为肺炎伴有真菌菌丝或孢子；（４）卡氏肺囊虫性肺炎（ＰＣＰ）（８３例），典型特征为肺泡腔内有泡沫状无细胞性渗出物，银染下可显示病原体。２３例为混合性感染。另发现２０例肺卡波西肉瘤，由梭形细胞和血管构成；５例恶性淋巴瘤，为大细胞型。结论：在艾滋病人中，肺部病变以机会性感染常见，而卡波西肉瘤和淋巴瘤少见。诊断以鉴定病原体及相关的形态学特征为依据。

Objective:The pulmonary lesions of 151 autopsy cases at Mount Sinai Medical Center in New York were studied to outline the spectrum and pathological features in the lung of the patients with AIDS.Methods:All cases were anatomized and sampled routinely,formaline fixed,paraffin embedded and stained with hematoxylin eosin.Histochemical stains and immunohistochemical studies were performed when necessary.Results:134 cases ( 88.7 %) had striking pulmonary lesions.The common infections included:1.CMV infection in 40 cases characterized by interstitial pneumonia and megalic cells with intranuclear inclusions;2.Mycobacteriosis including MAI infection(11) and tuberculosis(10);3.Pulmonary candidiasis(9),cryptococcosis(7),aspergillosis(6) manifested as pneumonia with fungal hyphae or spores;4.PCP in 83 cases(54.9%) characterized by typical foamy,acellular,intraalveolar exudates showing pathogen on silver stain 23 cases were mixed infected.Pultmonary Kaposi's sarcoma were found in 20 cases consisting of spindle cells and blood vessels.Malignant lymphoma were found in 5 cases which were of large cell type.Conclusions:Opportunistic infections are the most common types but Kaposi's sarcoma and lymphoma are less frequent in the lung of the patients with AIDS.The diagnosis are based on the identification of pathogens and the related morphological features.