新型甲型H1N1流感重症病例肝脏病理学变化分析  

Pathological analysis of liver in fatal influenza A(H1N1)virus infected cases

作　　者：王珏[1] 戴洁[1] 王大业[1] 吕福东[2] 胡子净[1] 金荣华[2] 齐晶[1] 段雪晶[1] 

机构地区：[1]首都医科大学基础医学院病理系,北京100069 [2]首都医科大学附属北京佑安医院病理科,北京100069

出　　处：《首都医科大学学报》2015年第3期437-440,共4页Journal of Capital Medical University

基　　金：首都医学科技发展基金资助(2009-2091)~~

摘　　要：目的从组织、细胞、蛋白水平,观察新型甲型H1N1流感病毒感染后肝脏的病理学变化特征,分析血凝素(hemagglutinin,HA)、核蛋白(nucleoprotein,NP)、CD68及转化生长因子β_1(transforming growth factorβ_1,TGF-β_1)在肝脏中的表达分布特点,以探讨重症死亡病例可能的发病机制。方法收集2009年北京甲型H1N1流感重症死亡系统解剖病例2例,床旁肝脏穿刺标本6例,通过常规病理学及免疫组织化学方法观察变化特征。结果肝脏存在不同程度充血及带状坏死,妊娠女性肝细胞伴有微泡型脂肪变。病毒抗原HA及NP在肝坏死区巨噬细胞中有少量表达;CD68主要表达在肝窦库普弗细胞及坏死区巨噬细胞;TGF-β_1主要表达在巨噬细胞,坏死区明显增多。结论新型甲型H1N1流感重症患者病理变化不仅局限于呼吸道,肝脏同样受累,其机制可能与CD68和TGF-β的作用相关。Objective In this study,we observed the pathological characteristics of liver after influenza A（HlNl） virus infection,studied the expression of hemagglutinin（HA）,nucleoprotein（NP）,CD68 as well as the transforming growth factor p,（TGF-p,） in the livers in the death cases,trying to discover the potential pathogenesis of the fatal H1N1.Methods Eight cases of fatal human influenza A（H1N1） infection,including 2 autopsy and 6 paramortem needle puncture biopsies were enrolled into the study.Histologic examination,special stain and immunohistochemical assays were carried out.Results In the hepatic cells band-like necrosis appeared.Micro-bubbled fatty change was observed in the hepatic cells of the pregnant women.Immunohistochemical study demonstrated the presence of nuclear protein（NP） and hemagglutinin（HA） virus antigens in macrophages.CD68 was positively expressed in hepatic kuffer’ cells.TGF-p was positively expressed in macrophages and the expression rate was significantly higher than that of controls in zone of necrosis.Conclusion The study indicated that the pathological changes of influenza A（H1N1） virus infected patients were not limited to the respiratory tract,the liver was another target.Its mechanism might be related to the role of CD68 and TGF-p in the course of the disease.

关 键 词：新型甲型H1N1流感 肝脏 病理特征 CD68 转化生长因子β(TGF-β1) 

分 类 号：R36[医药卫生—病理学]