慢性阻塞性肺疾病与肺构形重建

Chronic obstructive pulmonary disease and pulmonary structural remodeling

目的 观察慢性阻塞性肺疾病（ Ｃ Ｏ Ｐ Ｄ） 合并肺心病尸检２０ 例的肺部病变特征及其与肺构形重建的关系。方法 常规或低压（１８４ ～３３４ ｍ ｍ Ｈｇ） 福尔马林灌注固定肺组织。用点计数法检测大肺片的肺气肿百分值。常规切片、 Ｚｅｉｓｓ 显微测微器定量测量细支气管的病变特征和肺间质纤维化所占百分值。天狼猩红苦味酸染色，偏振光镜观察，真彩色图像分析Ⅰ、Ⅲ两型胶原分布比值。结果 Ｃ Ｏ Ｐ Ｄ 病例中以不规则型和囊泡型肺气肿最多见（１７／２０） ，１３ 例有中度和重度肺气肿，心重＞ ４００ｇ 者６ 例。肺纤维化组织占肺总切面积平均为（２７１ ±２９） ％ ，对照组为（１２０ ±１８） ％ ；Ⅰ型与Ⅲ型胶原面积比为５６∶１ ，对照组为１３∶１ ； Ｃ Ｏ Ｐ Ｄ 组１ ５０４ 支细支气管均有慢性细支气管炎，其中合并急性炎症者占３８ ％ ；管腔狭窄和纤维性闭锁者占５３ ％ 。结论 急、慢性细支气管炎和细支气管周围炎是 Ｃ Ｏ Ｐ Ｄ 的重要肺部病变，也是导致肺组织和血管构形重建的重要环节。

Objective To understand the pathological characteristics of the lungs in 20 autopsy cases of chronic obstructive pulmonary disease(COPD) complicated with cor pulmonale and its relationship with structural remodeling of the lungs Methods The lungs of 20 autopsy cases of COPD complicated with cor pulmonale were fixed in 10% formalin or by low pressure 18 4～33 4 mm Hg perfusion with 10% formalin The lungs were cut sagitally into large slices with 2 cm in thickness, and the percentage of the emphysematous areas was calculated by point counting The pathological characteristics of bronchioles and the stromal fibrosis area were examined microscopically and quantitatively using a latticed micrometer (Zeiss) The distribution and the ratio of type I to type Ⅲ collagen in the lung tissue were determined using a sirius red polarizing microscopy morphmetry method Results Of the 20 cases of COPD,irregular and saccular emphysema were the most frequent (17/20) 10 cases had moderate and high degree of emphysema, and 6 cases showed hypertrophy of the right ventricle (heart weight >400 g) The mean area of stromal fibrosis auounted for total area of the examined lungs was (27 1±2 9)% and control group (12 0±1 8)% The ratio of the area of the type Ⅰcollagen to type Ⅲ collagen was 5 6∶1 (control group 1 3∶1) All 1504 bronchioles showed chronic inflammation, 38% of which revealed acute exacerbation, and 53% of which showed lumen stenosis and fibrotic obstruction Conclusions Acute and chronic bronchiolitis and peribronchiolitis are the essential pathological changes in COPD, and also are the key link of the structural remodeling of the pulmonary tissue and vessels