特发性肺纤维化的电镜观察及发病机理的探讨  

Electron microscopic studies on pathogenesis of idiopathic pulmonary fibrosis

作　　者：汤秀英[1,2] 何冰[1,2] 李桂莲[1,2] 张烨[1,2] 柴立军[1,2] 

机构地区：[1]北京医科大学第一医院电镜室 [2]北京医科大学第一医院呼吸内科

出　　处：《中华结核和呼吸杂志》1999年第1期27-29,共3页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：国家自然科学基金

摘　　要：目的观察特发性肺纤维化的超微结构变化并探讨其发病机理。方法选择临床上提示特发性肺纤维化的患者９例，经支气管肺活检进行光镜和电镜观察。结果主要的形态学改变是：光镜下为肺泡炎和纤维化。电镜观察可见：（１）Ｉ型肺泡上皮细胞变性、崩解和脱落，内皮细胞肿胀，细胞间紧密连接短小，Ｉ型肺泡上皮细胞增生，基底膜变薄和破坏；（２）肺泡巨噬细胞、间质巨噬细胞增多；（３）肥大细胞浸润并见脱颗粒现象；（４）肺泡壁电子致密物沉积；（５）肌纤维母细胞、纤维母细胞、胶原原纤维及基底膜样物质增生。结论电镜观察可见特发性肺纤维化时肺泡上皮细胞、血管内皮细胞及基底膜均有损伤，并可见间质巨噬细胞增生，肥大细胞浸润及脱颗粒，肺泡壁电子致密物沉积。上述形态学改变对特发性肺纤维化的形成提供了一些依据。Objective To observe ultrastructural changes and study the pathogenesis of idiopathic pulmonary fibrosis. Methods The clinical manifestations in 9 patients with idiopathic pulmonary fibrosis were selected. Transbronchial lung biopsy materials were obtained for light microscopic and electron microscopic examination. Results The major morphologic changes were as follows: histologically, alveolar inflammation and interstitial fibrosis were observed. electron microscopic findings were: 1. alveolar type I cells were degenerated、 broken down and desquamated, endothelial cells were swelled, with inter cellular tight junction shortened, alveolar type II cells hyperplastic, basement membrane thinned and deformed; 2. alveolar macrophages and interstitial macrophages were hyperplastic; 3.mast cells were infiltrated and degranulated; 4.electron dense deposits were present at alveolar wall; 5. myofibroblasts 、fibroblasts、 collagen and basement membrane like material were hyperplastic. Conclusions Electron microscopic obser vations show that the alveolar epithelial cells, endothelial cells and basement membrane are all injured, interstitial macrophages hyperpplasia, mast cells infiltration and degranulation, electron dense deposits at alveolar wall are present. These morphologic changes provide basis for formation of idiopathic pulmonary fibrosis.

关 键 词：肺纤维化 巨噬细胞 发病机理 电镜观察 超微结构 

分 类 号：R563.902[医药卫生—呼吸系统]