人感染甲型H1N1流感病毒重症死亡病例的病理学观察

A histopathological study on Influenza A H1N1 infection in humans

目的:观察人感染甲型H1N1流感病毒重症死亡病例各主要脏器的病理改变。方法:按传染病尸体解剖要求对3例死亡病例进行系统解剖,并获得心、肝、脾、肺、脑和肾等全部脏器,组织常规HE染色和革兰氏染色,光学显微镜下观察。结果:3例病例主要致死性病变位于肺,呈现弥漫性肺泡损伤改变(坏死性细支气管炎、肺泡腔内有浆液性和/或纤维素性渗出、肺出血、肺透明膜形成),其中1例病程较长者部分区域伴肺泡上皮增生和肺间质纤维化,且合并细菌感染及肺脓肿,可见血管壁坏死,血管内血栓形成,1例有心肌水肿,1例有脑出血和脑液化性坏死。结论:人感染甲型H1N1流感病毒后主要累及呼吸系统,患者最终因急性呼吸窘迫综合征和多器官功能衰竭死亡。

Objective：To find histopathological changes on major organs of Influenza A H1N1-infected patients and its relationship to clinical symptoms.Methods：The autopsies were performed following conventional protocols and strict safety procedures.Tissue samples from all major organs of three cases were collected and fixed in 4% formalin.The histopathological changes on these samples were observed under a light microscope.Results：The lungs of some damaged areas of three cases showed diffuse alveolar damage（DAD） with hyaline membranes formation and intra-alveolar edema and/or fibrin.Most areas of the lungs in the three cases showed necrotizing bronchiolitis,hemorrhage,secondary infection,thrombsis and focal alveolar necrosis.The lungs exhibited proliferation of pneumocytes and fibrosis of the interstitium in one case.In one case,the brain showed focal hemorrhage and focal liquefactive necrosis.In one case,the heart showed edema.Conclusion：The respiratory tract is the major target of influenza A H1N1 virus.The changes of DAD with secondary infection in the lung resulted in hypoxia,leading to multiple organ failure and death.