Pathological and ultrastructural analysis of surgical lung biopsies in patients with swine-origin influenza type A/H1N1 and acute respiratory failure.
Pathological and ultrastructural analysis of surgical lung biopsies in patients with swine-origin influenza type A/H1N1 and acute respiratory failure.
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DOI：
10.1590/s1807-59322010001200003
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发表时间：
2010
期刊：
影响因子：
--
通讯作者：
Duarte MI
中科院分区：
文献类型：
--
作者：
Capelozzi VL;Parra ER;Ximenes M;Bammann RH;Barbas CS;Duarte MI
当混合感染或肺损伤主导免疫反应时，H1N1和其他肺部感染病例会演变为急性呼吸衰竭和死亡，因此需要早期诊断以改善治疗。对5例确诊为甲型H1N1流感的ARDS患者的肺活检标本进行详细的组织病理学分析。对肺标本进行微生物学分析，并进行光学和电子显微镜检查。免疫表型检测巨噬细胞、自然杀伤细胞、T、B细胞及细胞因子和诱导型一氧化氮合酶的表达。病理表现为坏死性毛细支气管炎、弥漫性肺泡损伤、肺泡出血和免疫反应异常。超微结构分析显示，所有病例均有病毒样颗粒。通过超微结构检查可以在肺组织中成功地显示病毒样颗粒，而鼻咽抽吸物上的RT-PCR不能证实病毒。感染的主要靶点可能是细支气管和上皮，而不是内皮，弥漫性肺泡损伤是呼吸道闭塞和功能障碍对天然免疫的影响的结果，提示治疗应侧重于上皮修复。
Cases of H1N1 and other pulmonary infections evolve to acute respiratory failure and death when co‐infections or lung injury predominate over the immune response, thus requiring early diagnosis to improve treatment. To perform a detailed histopathological analysis of the open lung biopsy specimens from five patients with ARDS with confirmed H1N1. Lung specimens underwent microbiologic analysis, and examination by optical and electron microscopy. Immunophenotyping was used to characterize macrophages, natural killer, T and B cells, and expression of cytokines and iNOS. The pathological features observed were necrotizing bronchiolitis, diffuse alveolar damage, alveolar hemorrhage and abnormal immune response. Ultrastructural analysis showed viral‐like particles in all cases. Viral‐like particles can be successfully demonstrated in lung tissue by ultrastructural examination, without confirmation of the virus by RT‐PCR on nasopharyngeal aspirates. Bronchioles and epithelium, rather than endothelium, are probably the primary target of infection, and diffuse alveolar damage the consequence of the effect of airways obliteration and dysfunction on innate immunity, suggesting that treatment should be focused on epithelial repair.
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