猴痘病毒感染性皮疹24例临床病理学特征  

Clinicopathological study of 24 cases of monkeypox virus infection-related rashes

作　　者：庞艳华 周新刚[2] 李慢[2] 陈香梅 张亮[2] 杨坤 刘婷 陈佳敏 刘思梦 佟伟民 陆江阳[4] 王鹏[2] Pang Yanhua;Zhou Xingang;Li Man;Chen Xiangmei;Zhang Liang;Yang Kun;Liu Ting;Chen Jiamin;Liu Simeng;Tong Weimin;Lu Jiangyang;Wang Peng(Department of Dermatology,Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China;Department of Pathology,Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China;Department of Pathology,Institute of Basic Medicine,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100005,China;Department of Pathology,the Fourth Medical Center of People's Liberation Army General Hospital,Beijing 100010,China)

机构地区：[1]首都医科大学附属北京地坛医院皮肤科,北京100015 [2]首都医科大学附属北京地坛医院病理科,北京100015 [3]中国医学科学院北京协和医学院基础学院病理学系,北京100005 [4]解放军总医院第四医学中心病理科,北京100010

出　　处：《中华病理学杂志》2024年第10期1011-1017,共7页Chinese Journal of Pathology

摘　　要：目的通过对一组猴痘患者的临床病理学研究,明确其特殊性皮疹的病理学特征和相应检测方法。方法收集首都医科大学附属北京地坛医院2023年6—8月期间就诊的猴痘病例,对其中取得皮肤活检的24例患者进行临床病理学研究。临床方面收集患者的病史、皮疹图片和核酸检测结果。病理研究方法包括组织学、免疫组织化学染色、RNAscope^((R))杂交和电镜观察。结果24例患者均为男性,其中人免疫缺陷病毒(HIV)感染患者14例。平均年龄(32.3±5.4)岁,经核酸检测确认猴痘病毒阳性。临床上皮疹多为单个,偶见簇状分布。猴痘皮疹多散在分布,皮疹出疹时相相近。皮疹常见的部位,依次是会阴部、面部、四肢和躯干,数量(13.0±11.8)个。组织学上,猴痘皮疹的病理学特征有表皮棘细胞层气球样变、胞质内Guarnieri小体、真皮层深在的炎性细胞浸润等。免疫组织化学染色、RNAscope^((R))杂交和电镜检查均可有效检测到猴痘病毒,同时电镜观察到病毒可以在多种细胞内复制。结论通过病理学活检有助于猴痘病毒感染皮疹的诊断和鉴别;研究证实猴痘病毒具有明显的上皮亲嗜性,病毒可以感染皮肤组织的多种细胞。ObjectiveTo investigate the clinicopathological characteristics of rashes in monkeypox patients through a series of skin biopsies,and examine their pathological features and the most effective tests.MethodsPatients with monkeypox virus infection admitted to Beijing Ditan Hospital from June to August 2023 were identified.Among them,24 patients underwent skin biopsies for clinical pathological study that were included in this study.Clinical information,rash pictures,and nucleic acid test results were analyzed using histopathology,immunohistochemistry,RNAscope^((R))hybridization and electron microscopy.ResultsAll 24 patients were male,including 14 patients with concurrent human immunodeficiency virus infection.Their average age was(32.3±5.4)years.The nucleic acid test confirmed monkeypox virus infection.The clinical feature of monkeypox rashes was solitary rather than clustered distribution,with rashes occurring in similar phase,distinguishing it from herpesvirus.The rashes in these patients were mostly scattered,with an average of(13.0±11.8)rashes,and most commonly present in the perineum,face,limbs,and trunk.The three main pathological features of these rashes were ballooning degeneration of the epidermal spinous cell layer,the characteristic intra-cytoplasmic Guarnieri′s bodies and significant infiltration of inflammatory cells in whole dermal layer.Immunohistochemistry,RNAscope^((R))hybridization,and electron microscopy can all effectively detect the monkeypox virus.Electron microscopy showed viral replication in various types of skin cells.ConclusionsThe study describes the pathological features of monkeypox virus rashes.Pathological examination of skin biopsy samples is helpful to diagnose these rashes.The study suggests that the monkeypox virus has a unique epitheliotropic affinity and can infect various types of cells in the skin.

关 键 词：猴痘病毒 皮肤 病理学 致细胞病变 病毒 原位杂交 

分 类 号：R511[医药卫生—内科学] R752[医药卫生—临床医学]