Histopathological findings in a critically ill patient with avian influenza A (H7N9).
Histopathological findings in a critically ill patient with avian influenza A (H7N9).
复制标题
DOI：
10.3978/j.issn.2072-1439.2015.11.59
复制
发表时间：
2015-07
影响因子：
2.5
通讯作者：
Jinbao Huang;Hongye Li;Jia-fu Liu;C. Lan;Q. Lin;Shu-xing Chen;Hong-Ying Zhang;Xinhang Wang;Xu Lin;Jian-Guang Pan;H. Weng
中科院分区：
文献类型：
--
作者：
Jinbao Huang;Hongye Li;Jia-fu Liu;C. Lan;Q. Lin;Shu-xing Chen;Hong-Ying Zhang;Xinhang Wang;Xu Lin;Jian-Guang Pan;H. Weng
迄今为止，有关人类 H7N9 疾病肺部组织病理学的数据很少。我们在此描述了一名患有甲型禽流感（H7N9）重症的患者。胸部计算机断层扫描 (CT) 扫描显示整个肺部有弥漫性磨玻璃样混浊和实变。因右侧气胸持续漏气，于发病第23天，采用基于体外膜肺氧合（ECMO）支持技术的电视胸腔镜手术（VATS）切除右中叶肺大泡。切除的肺组织的组织病理学结果显示肺细胞增生和纤维增殖性变化以及弥漫性肺泡损伤。尽管接受了奥司他韦治疗，但支气管肺泡灌洗液（BALF）标本中甲型H7N9流感病毒持续呈阳性超过三周，并且持续的病毒复制显着延长了病程。患者的临床状态不断恶化，由于进行性和快速的肺纤维化而出现难治性低氧血症，这一点通过有限的死后肺组织活检观察到的最终组织学变化得到证实。临终前，尽管接受了皮质类固醇治疗，他还是出现了多器官衰竭，并在症状出现后第 39 天死亡。
To date, data regarding the pulmonary histopathology of human H7N9 disease are scarce. We herein describe a patient with a severe case of avian influenza A (H7N9). A chest computerized tomography (CT) scan showed diffuse ground-glass opacities and consolidation throughout the lungs. A resection of pulmonary bullae in the right middle lobe was performed by video-assisted thoracic surgery (VATS) based on the extracorporeal membrane oxygenation (ECMO) supportive technique on the 23(rd) day after the onset of symptoms because of a right pneumothorax persistent air leak. The histopathological findings of the resected lung tissue revealed pneumocyte hyperplasia and fibroproliferative changes along with diffuse alveolar damage. Bronchoalveolar lavage fluid (BALF) specimens for influenza A (H7N9) virus were continuously positive for more than three weeks, despite oseltamivir treatment, and continuous viral replication significantly prolonged the course of the disease. The patient's clinical status continuously deteriorated, with the development of refractory hypoxemia due to progressive and rapid lung fibrosis, which was confirmed by the final histological changes observed from a limited post-mortem biopsy of lung tissue. Pre-terminally, he developed multi-organ failure and died on the 39(th) day after symptom onset, despite corticosteroid treatment.