摘要
目的了解甲型H1N1流感病毒感染患儿临床与病理特征。方法分析甲型H1N1流感病毒感染1例死亡病例临床资料和尸检结果,并结合文献分析。结果男性,1岁4个月,以咳嗽和发热起病,起病1d后即出现呼吸困难和呼吸衰竭。采用WHO推荐的RT-PCR法和国家流感中心推荐的分型方法,患儿咽拭子结果示甲型H1N1流感病毒核酸检测阳性,2次气管抽取物培养均为肺炎链球菌。予机械通气等治疗无好转,入院第4天死亡。尸检结果显示:病变主要在肺脏,大体可见大片状实变,灰褐色,质韧;胸膜粘连广泛。镜下显示肺弥漫性肺泡间质增宽,大部分肺泡可见透明膜形成,肺泡有炎性渗出,可见中性粒细胞、淋巴细胞、单核细胞,肺泡上皮肿胀,有巨细胞形成,部分肺泡塌陷闭合,小部分肺泡扩张融合;细支气管和支气管黏膜见较多淋巴细胞浸润,局灶黏膜糜烂。脑、心、肝、脾、肾、肾上腺、胰腺和胃肠道病理改变不明显。结论本例甲型H1N1流感死亡患儿上呼吸道症状突出,病情进展快。病理改变主要在肺脏,以炎症渗出、炎细胞浸润和肺透明膜形成为主。死亡主要原因为急性呼吸窘迫综合征,呼吸循环衰竭。
Objectives To study the clinical and pathological feature of the children infected with influenza A H1N1 virus. Methods The clinical material and result of the autopsy of a died child infected with influenza A H1N1 virus were analyzed. Results A child,one year and four months old, onset with fever and cough, progressed to dyspnea and lung failure in one day. The throat swab showed that the nucleic acid detection of influenza A H1N1 virus was positive by （real time PCR） RT-PCR recommended by WHO and National Influenza Reference Center of China. Streptococcus pneumoniae grew in the trachea secretion bacteria culture. Autopsy showed the main lesions in the lung. Gross： 90% of the section in the lung presented with consolidation, taupe, pleural adhesion wildly, involved pericardium exine. Microscopic： diffuse alveolar interstitial tissue was broadened,most of the alveolar walls were covered by substance like hyaline membrane,more than 90% of the alveolar spaces were full with inflammatory exudate,neutrophils,lymphocytes,monocytes and giant cells. Some of the alveoli collapsed and closed, some of the alveoli showed ectasia and fusion. Inflammatory exudate was found in the bronchiole and bronchial intralumen. There were more lymphocytic infiltration in tip of the wall. Lung membrane was edematous. There were more lymphocytic infiltration in tip of the tracheal mucosa, or focal mucosal erosion. There was no obvious pathological change in the brain,heart, liver, spleen , kidney, adrenal gland, pancreas or gastrointestinal tract. Conclusions This H1N1 case with severe pneumonia was rapidly progressed and featured with pathological changes in his lung, such as inflammation, exudative and hyaline membrane formation. Main causes of the death were acute respiratory distress syndrome, respiratory and circulatory failure.
出处
《中国循证儿科杂志》
CSCD
2012年第2期141-144,共4页
Chinese Journal of Evidence Based Pediatrics
