甲型H1N1流感伴呼吸衰竭患者针吸肺活检病理分析

Pathological Analysis of Aspiration Lung Biopsy Specimens from Patients with Type A H1N1 Influenza and Respiratory Failure

目的分析甲型H1N1流感呼吸衰竭患者的针吸肺活检病理资料,总结其特点,以指导临床治疗。方法收集2009年10月以来兰州大学第一医院重症医学科收治5例甲型H1N1流感呼吸衰竭患者的临床、影像及针吸肺活检病理资料,并进行综合分析,探讨治疗策略。结果甲型H1N1流感危重症呼吸衰竭患者典型临床表现为:感冒症状后病情迅速进展,高热,呼吸困难,严重低氧血症,咯大量粉红色血性痰,双肺大量湿啰音,累及其他脏器,休克。肺部病理早期特征为肺泡及肺间质炎性渗出,炎性细胞浸润,广泛微小出血灶;中晚期特征为肺泡上皮增生,肺泡隔断裂,肺泡腔消失,代之以纤维素样物及增生的纤维组织。结论甲型H1N1流感危重症呼吸衰竭肺部病理特征为早期炎性渗出,间质充血水肿伴淋巴细胞浸润,肺泡腔浆液纤维素渗出及红细胞漏出;晚期肺间质纤维化伴肺泡闭锁。在全身治疗、机械通气策略、糖皮质激素及抗氧化治疗等方面应根据甲型H1N1流感肺部病理特点制定应对策略。

Objective To analyze the lung pathological features of type A H1N1 influenza and respiratory failure.Methods The data of imaging and aspiration lung biopsy of five patients with type A H1N1 influenza and respiratory failure since October 2009 were retrospectively analyzed.Results Common clinical manifestations of patients with type A H1N1 influenza and respiratory failure were rapid progress of illness after common cold-like symptoms with high fever,dyspnea,severe hypoxemia,large amounts of bloody sputum,wet rales over both lungs,and with other organs involved or even septic shock.Early lung pathological features were inflammatory exudate in alveoli and lung interstitium,infiltration of inflammatory cells,and extensive hemorrhage.Middle and late pathological features were hyperplasia of alveolar epithelial,disconnection of alveolar septa,replaced of alveolar spaces by fibrosis.Conclusions The pathology of patients with type A H1N1 influenza and respiratory failure is similiar with ARDS.Development of treatment strategies targeted to pathological characteristics of ARDS caused by type A H1N1 influenza is of great significance for effective and timely treatment.