新型冠状病毒感染疾病十例穿刺尸检病例脾脏病理学改变  

Pathological changes of the spleen in ten patients with coronavirus disease 2019(COVID-19)by postmortem needle autopsy

作　　者：许霞 常晓娜 潘华雄 苏华[2] 黄博 杨明 罗丹菊 翁密霞 马琳 聂秀[1] Xu Xia;Chang Xiaona;Pan Huaxiong;Su Hua;Huang Bo;Yang Ming;Luo Danju;Weng Mixia;Ma Lin;Nie Xiu(Department of Pathology,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China;Department of Nephrology,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China)

机构地区：[1]华中科技大学同济医学院附属协和医院病理科,武汉430022 [2]华中科技大学同济医学院附属协和医院肾内科,武汉430022

出　　处：《中华病理学杂志》2020年第6期576-582,共7页Chinese Journal of Pathology

基　　金：科技部"公共安全风险防控与应急技术"重点专项(2020YFC0845700);中央高校基本科研业务费专项资金资助(2020kfyXGYJ101)。

摘　　要：目的观察新型冠状病毒感染疾病(COVID-19)患者的脾脏病理改变,探讨患者免疫系统功能低下与脾脏病变之间的关系。方法对武汉地区10例因COVID-19死亡患者进行穿刺尸检,获取脾脏组织。采用常规HE染色观察脾脏的形态学改变,免疫组织化学染色分析脾脏的免疫结构变化,逆转录-聚合酶链反应(RT-PCR)方法检测脾脏中新型冠状病毒(2019-nCoV)核酸,原位杂交检测EB病毒,2例行透射电镜查找冠状病毒颗粒,并结合患者的临床资料进行分析。结果男性7例,女性3例;年龄39~87岁,平均年龄68.3岁。10例中4例有癌症病史,4例有基础性疾病。咳嗽、发热、全身乏力及呼吸困难是主要的临床症状。患者从症状出现到死亡的时间15~45 d。10例患者外周血白细胞计数在疾病早期正常或轻度增高,6例患者死亡前明显增高,5例患者外周血淋巴细胞计数在疾病早期便出现减少,10例患者在疾病进展或死亡前均明显减少。7例患者使用激素治疗(甲泼尼龙≤40 mg/d,连用不超过5 d)。组织病理学改变见脾脏细胞成分减少,白髓呈不同程度萎缩,淋巴滤泡减少或缺如;红髓与白髓比例不同程度升高;70%病例见较多中性粒细胞浸润,50%病例见散在浆细胞浸润;1例见巨噬细胞增生,少数细胞内见嗜血现象;2例检出坏死及淋巴细胞凋亡;1例检出小动脉血栓及脾脏梗死;1例出现真菌感染及髓窦内见泡沫状组织细胞增生。免疫组织化学检测显示所有病例脾脏T、B淋巴细胞成分均呈不同程度的减少。8例COVID-19患者的脾脏见CD20+B细胞聚集于脾动脉周围淋巴鞘,2例CD20及CD21显示白髓数量大致正常,淋巴滤泡萎缩。CD3+、CD4+及CD8+T细胞均减少。CD68显示9例巨噬细胞分布及数量无明显变化,1例髓窦内见较多CD68阳性细胞(与合并真菌感染有关)。查见个别CD56阳性细胞。原位杂交检测EB病毒均为阴性。RT-PCR方法检测2019-nCoV核酸,10例中有1例Objective To study the pathological changes of the spleen in patients with COVID-19 and to analyze the relationship between the weakened immune system and splenic lesions.Methods Postmortem needle autopsies from the spleen were carried out on 10 patients who died from COVID-19 in Wuhan.Routine hematoxylin and eosin(HE)staining was used to observe the pathological changes.The changes of lymphocytes were studied further with immunohistochemistry.RT-PCR was used to detect 2019-nCoV RNA in the spleen.In addition,the Epstein-Barr virus(EBV)was detected by in situ hybridization,and coronavirus particles were detected by transmission electron microscopy in 2 cases.Results There were 7 males and 3 females,with an average age of 68.3 years.Of the 10 cases,4 had cancer history and another 4 had other underlying diseases respectively.Cough,fever,malaise and dyspnea were the main clinical symptoms.The time from onset to death was 15-45 days.Ten cases patients had normal or slight increase in peripheral blood leukocyte count in the early stage of the disease,6 cases had significant increase before death.Five patients′peripheral blood lymphocyte count decreased in the early stage of the disease,and 10 patients′peripheral blood lymphocyte count decreased significantly before the disease progressed or died.Seven cases were treated with corticosteroid(methylprednisolone≤40 mg/d,not more than 5 days).Histopathological examination showed that the cell composition of the spleen decreased,white pulp atrophied at different levels,meanwhile lymphoid follicles decreased or absent;in addition,the ratio of red pulp to white pulp increased with varying degrees.In 7 cases,more neutrophil infiltration was found,and in 5 cases,scattered plasma cell infiltration was found.Macrophage proliferation and hemophagocytic phenomena in a few cells were found in a case.Meanwhile,necrosis and lymphocyte apoptosis were detected in 2 cases,small artery thrombosis and spleen infarction in 1 case,and fungal infection in 1 case.The results of immunohis

关 键 词：脾 穿刺术 病理过程 新型冠状病毒感染疾病 

分 类 号：R51[医药卫生—内科学]