肺泡蛋白沉积症患者痰液沉淀物的超微结构特点及其诊断价值  

The ultrastructural features of sputum deposition and its value in the diagnosis of pulmonary alveolarproteinosis

作　　者：罗本芳[1] 李惠萍 易祥华[4] 陶巨蔚[1] 吕寒静 方霞[4] 张宗梅[4] 张龙[4] 任胜祥 褚海青 李霞 曾郁[4] 

机构地区：[1]同济大学附属上海市肺科医院特检科,200433 [2]呼吸科 [3]肿瘤科 [4]同济大学附属同济医院 上海市同济医院病理科

出　　处：《中华结核和呼吸杂志》2012年第12期887-891,共5页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：上海市科学技术委员会科研基金（034119868）;上海市科学技术委员会科研基金医学重点资助项目（09411951600）

摘　　要：目的探讨肺泡蛋白沉积症（PAP）患者痰液沉淀物（SD）的超微结构特点及其诊断价值。方法选择同济大学附属上海市肺科医院和同济大学附属同济医院2000年1月至2009年12月间经肺活检和细胞学病理诊断的PAP患者7例（PAP组），其中男5例，女2例，中位年龄48岁（36-73岁）；将SD和BALF离心沉淀物分别制作超薄切片，透射电镜比较观察。同期选取具有双肺浸润性病变（细菌性肺炎3例，COPD和浸润性肺结核各2例）患者7例（对照组），其中男4例，女3例，中位年龄49岁（39-68岁）；每例sD制作超薄切片，与PAP组透射电镜观察结果比较分析。结果PAP组7例患者中痰直接涂片淀粉酶消化后过碘酸雪夫染色未检出有诊断意义的细胞成分；BALF沉淀物石蜡包埋切片细胞学光镜观察，4例符合PAP。BALF透射电镜观察，肺泡上皮细胞内以及细胞外有大量同心圆状的板层小体，5例符合PAP诊断。SD的透射电镜观察，巨噬细胞胞质内有较多髓鞘样的吞噬体，肺泡上皮细胞内有较多的板层小体，细胞外有较多同心圆状的板层小体，细胞和板层小体明显退变，4例符合PAP诊断，sD和BALF比较在电镜诊断PAP上差异无统计学意义（X^2=1．000，P〉0．05）。对照组7例中均未检出细胞外游离的嗜锇板层小体。结论PAP患者SD和BALF样本中均可检出具有诊断意义的嗜锇板层小体，结合临床和影像学可以对PAP作出明确的诊断，尤其对于肺活检和肺泡灌洗有禁忌证的患者，是协助诊断PAP的一个重要方法。Objective To investigate the ultrastructural features of sputum deposition（SD） and its value in the diagnosis of pulmonary alveolar proteinosis （PAP）. Methods Seven patients with PAP diagnosed by lung biopsy and cytology were enrolled in this study. The patients consisted of 5 men and 2 women, whose median age was 48 years （range 36 to 73 ）. SD and bronchoalveolar lavage fluid （BALF） sediment were made into ultrathin sections and observed under transmission electron microscope （ TEM）, respectively. Seven cases of control group composed of 4 men and 3 women whose median age was 49 years （range 39 to 68） including 3 cases of bacterial pneumonia, two cases of COPD and 2 cases of exudative pulmonary tuberculosis. Each SD was made into ultrathin section, and compared with the experimental group. Results In PAP group, Periodic acid-schiff （PAS） staining was performed on 7 sputum smears and none of them was tested positive for any components with diagnostic interest. Four cases from the 7 paraffin- embed sections of BALF sediment by microscopic examination suggested PAP. Under TEM, BALF sediment showed that many lamellar bodies existed in and outside alveolar epithelial cells, and 5 specimens wereconsistent with PAP diagnosis. Compared with BALF sediment, SD had apparent degeneration with more myelin phagosomes in the cytoplasm of macrophages, more lamellar bodies in alveolar epithelial ceils, and lots of lamellar bodies in the shape of concentric circle in the extracellular spaces. Four from the 7 SD samples were consistent with the diagnosis of PAP. No significant difference was found between SD and BALF in the diagnosis of PAP by electronic examination （P 〉 0. 05 ）. In the 7 cases of control group no drifting osmiophilic lamellar bodies in extracellular space were detected. Conclusions The osmiophilic lamellar bodies with diagnostic value were found in SD and BALF of patients with PAP. TEM of SD in combination with clinical manifestations and radiologic findings can make a definitive

关 键 词：肺泡蛋白沉积症 痰 支气管肺泡灌洗液 显微镜检查 电子 透射 

分 类 号：R563.9[医药卫生—呼吸系统]