鼻硬结病的病原学检测及病理形态观察

An etiological and pathologic study of Rhinoscleroma

目的 研究鼻硬结病的临床病理特点 ,探讨鼻硬结病的发病及组织损伤的机理。方法 以 33例鼻硬结病患者的组织标本为研究对象 ,全部用组织化学Warthin Starry(W S)染色 ,5例进行透射电镜观察。结果 经W S染色在肉芽肿内的Mikulicz细胞内检测出大量短棒状鼻硬结杆菌 ,细胞外偶见。电镜显示Mikulicz细胞内出现大量吞噬泡 ,将细胞器挤到一侧 ,粗面内织网及溶酶体很少。绝大多数鼻硬结杆菌寄宿于Mikulicz细胞的吞噬泡内 ,数量多达十几条 ,细菌壁有一层高电子密度的粗、细颗粒 ,显示胞内菌的特点。结论 鼻硬结杆菌可能是一种兼性胞内菌 ,具有抵抗巨吞噬细胞降解 ,能在巨吞噬细胞内大量繁殖和传播的能力 ,而肉芽肿形成和纤维化是造成组织损伤的主要原因。

Objective To investigate the clinicopathologic characteristics and mechanism of tissue injury caused by Klebsiella rhinoscleromatis (KR) infection. Methods Thirty-three cases of rhinoscleromas in the nasal and pharyngeal region seen in this hospital from Jan.1980 to Mar.2000 were studied retrospectively. Warthin-Starry(W-S) stain was used to study all cases. Five cases were studied further with transmission electron microscope. Results W-S stain revealed a great number of KR in Mikulicz cells within the granuloma. Electron microscopy demonstrated a number of phagosomes in the cytoplasm of Mikulicz cells where many KR were found. A small number of other organelles such as endoplasmic reticulums and lysozymes were squeezed to the side of cells. There were many granular substances on the surface of intracellular bacteria, which were not found on the extracellular KR. Conclusion KR is a facultative intracellular bacteria that is able to resist the digestion of macrophages and to proliferate in them. Formation of granulomas and fibrosis in KR infiltrated regions is the major cause of tissue injury.