脑死亡供体肺病理改变及临床移植应用的可行性

背景：有学者认为在脑死亡过程中很多因素可导致肺组织的改变。 目的：观察脑死亡供体肺病理改变,探讨其临床移植应用的可行性。 方法：对23例脑死亡供体肺进行了病理活检,苏木精-伊红染色、银染及PAS染色观察肺脏组织变化,电镜观察肺脏超微结构变化。 结果与结论：苏木精-伊红、银染及PAS染色光镜下见支气管及肺泡结构尚完整,局部病灶见肺泡内皮细胞水肿、坏死、脱落,肺泡间隔未见明显增宽,但充血易见,血管周围有少量出血,有散在淋巴细胞;电镜下脑死亡的肺泡细胞轻微水肿,部分细胞胞核染色质沿皱缩的核膜下凝聚,有的细胞核出现变型,细胞线粒体肿胀,但未见明显坏死。说明脑死亡供肺可以实施临床移植。     

GPC-II-3液间歇低温灌流保存兔肺的形态学观察

目的探讨对移植供肺具有长期保护作用的新技术。方法用自制的GPC-Ⅱ-3液,以间歇低温灌流的方法保存兔肺24～192h,观察其组织结构的变化。结果保存120h以内的肺,其组织结构与对照组无明显区别,肺泡、各级支气管、血管的结构清楚、支气管上皮结构完整清楚,上皮细胞胞核清晰,染色质分布均匀、肺泡完整,肺泡上皮和毛细血管内皮清楚。部分肺泡腔中,可见结构清楚的尘细胞及其吞噬的粉尘颗粒;保存144h的肺,细胞成分的染色似乎有所加深,其余结构无明显变化。保存168h的肺,肺泡、各级支气管、血管的结构依然清楚,但细胞成分的染色有所加深,部分支气管上皮细胞有脱落现象。保存192h的肺,细胞成分的染色明显加深,有固缩迹象,支气管上皮有脱落现象加重。结论用GPC-Ⅱ-3液以低温冷藏的方法能够保存兔肺的组织结构120h。     

GPC-Ⅱ-3液间歇低温灌流保存兔肺的形态学观察

目的探讨对移植供肺具有长期保护作用的新技术。方法用自制的GPC-Ⅱ-3液，以间歇低温灌流的方法保存兔肺24～192h，观察其组织结构的变化。结果保存120h以内的肺，其组织结构与对照组无明显区别，肺泡、各级支气管、血管的结构清楚、支气管上皮结构完整清楚，上皮细胞胞核清晰，染色质分布均匀、肺泡完整，肺泡上皮和毛细血管内皮清楚。部分肺泡腔中，可见结构清楚的尘细胞及其吞噬的粉尘颗粒；保存144h的肺，细胞成分的染色似乎有所加深，其余结构无明显变化。保存168h的肺，肺泡、各级支气管、血管的结构依然清楚，但细胞成分的染色有所加深。部分支气管上皮细胞有脱落现象。保存192h的肺，细胞成分的染色明显加深，有固缩迹象，支气管上皮有脱落现象加重。结论用GPC-Ⅱ-3液以低温冷藏的方法能够保存兔肺的组织结构120h。     

棉子糖低钾右旋糖酐液供体肺灌注保存的临床病理学研究

目的探讨棉子糖低钾右旋糖酐液(raffinose-low-potassium dextran solution,R-LPD液)供肺灌注低温保存后的组织形态学变化。方法应用光镜、电镜和免疫组化技术对R-LPD液灌注的18例肺移植供肺标本按不同的时间段进行观察。结果R-LPD供肺灌注低温保存的最佳时间是6~8h,随着保存时间延长,供体肺的形态结构改变也逐渐明显,保存30h时,可见肺泡壁及血管周围间质组织水肿,肺泡间隔断裂,部分肺泡上皮细胞变性、坏死、脱落。结论R-LPD液在肺移植冷缺血保存期中起较好的肺泡上皮细胞保护作用,比低钾右旋糖酐液(low-potassium dextran solution,LPD液)具有明显的优越性。     

脑死亡供体肾脏病理改变及移植应用标准评判的探讨

目的探讨脑死亡供体肾脏病理改变及对临床使用的指导意义。方法对13例脑死亡供体26个肾脏进行了穿刺活检,做HE染色、网状纤维染色及PAS染色。结果发现大多数患者均有不同程度的近曲小管坏死,而远曲小管、肾小球、基底膜多无改变。选择肾近曲小管上皮细胞坏死〈50%、肾小球无明显改变、肌酐〈250μmol/L、年龄〈55岁的供体26个肾脏施行了移植,均取得成功。结论脑死亡供体肾脏根据穿刺病理活检改变并结合临床表现可以作为临床移植的评判依据。     

严重急性呼吸综合征患者尸解肺标本的病理改变和致病机制研究

目的研究严重急性呼吸综合征（SARS）患者尸解肺标本的病理改变和致病机制。方法观察了2003年4-7月期间死于SARS的6例患者的肺标本,并采用光镜、电镜、Masson三色染色和免疫组织化学染色方法（EnVision法）进行研究。结果肺标本的病理形态改变：（1）6例的双肺均可见到弥漫性实变病灶,肺重量明显增加;（2）6例均可见到弥漫性肺泡损伤,包括透明膜形成、肺泡腔内水肿／出血、纤维素沉积和肺泡上皮细胞脱屑,AE1／AE3免疫组织化学染色显示肺泡上皮细胞的完整性明显破坏;（3）Ⅱ型肺泡上皮细胞轻度增生,有一定异型性,细胞体积增大,胞质呈双染性和颗粒状,胞质内可见小脂肪空泡聚集（5／6）;（4）6例中有5例可见巨细胞在肺泡内浸润,巨细胞大多AEl／AE3阳性（5／6）,少数CD68阳性（2／6）;（5）组织学形态和免疫组织化学染色证实肺泡腔内和肺泡间隔内有多量巨噬细胞浸润（6／6）;（6）6例中有5例可见巨噬细胞噬红细胞象;（7）6例中有5例可见肺纤维化,包括肺泡间隔和肺间质增宽（5／6）、肺泡腔内渗出物机化（6／6）和胸膜增厚（4／6）。Masson三色染色证实胶原纤维明显增生,免疫组织化学染色显示大多数为Ⅲ型胶原。光镜和免疫组织化学染色显示5例有明显的成纤维细胞／肌纤维母细胞增生灶;（8）5例可见支气管黏膜鳞状上皮化生;（9）6例患者均可见血栓;（10）2例同时合并其他感染,1例合并细菌感染,另1例合并真菌感染。此外,电镜发现在肺泡上皮细胞和肺血管内皮细胞的胞质内有冠状病毒样颗粒。结论SARS冠状病毒直接损伤肺泡上皮细胞、巨噬细胞明显浸润和成纤维细胞／肌纤维母细胞显著增生在SARS的致病机制中起重要作用。     

犬慢性肺缺血再灌注损伤的病理形态学观察

目的 研究犬慢性缺血再灌注肺损伤的病理形态学改变。方法 利用4只杂种犬建立慢性肺缺血再灌注实验模型，在光镜和电镜下观察慢性缺血期和再灌注期肺组织病理形态学改变，计算受损肺泡百分率。结果 缺血期：左肺部分区域灶性肺泡出血及肺泡膨胀不全，部分肺泡上皮细胞及肺血管内皮细胞线粒体空泡化、嵴溶解，同例对照右肺正常；再灌注期：左肺肺泡出血加重，肺间质和肺泡腔内有水肿液，肺血管内中性粒细胞聚集，受损肺泡百分率明显增加，部分肺泡上皮细胞和肺血管内皮细胞线粒体空泡化、嵴溶解加重，并出现肺泡上皮细胞坏死，同例右肺较左侧病变轻。结论 肺组织缺血期损伤不明显，再灌注期出现比较明显的肺损伤。     

大鼠肢体缺血再灌注后肺组织一氧化氮合酶的变化

目的:研究正常大鼠肺组织内一氧化氮合酶(NOS)的分布及肢体缺血再灌注(LIR)后肺组织内NOS分布及活性的变化。方法:用止血带复制肢体缺血再灌注模型,利用β-NADPH-d组织化学方法、计算机图像分析系统及分光光度法,观察对照组大鼠肺内NOS的分布及LIR组肺内NOS分布及活性的变化。结果:组织学上显示,对照组大鼠呼吸道包括支气管、细支气管、终末细支气管、肺泡管的上皮细胞和血管内皮细胞NOS表达均阳性,肺泡上皮细胞NOS表达阴性;LIR组上述肺组织阳性部位NOS表达增强,且出现血管平滑肌细胞、肺泡上皮细胞NOS表达阳性;生化测定结果显示,LIR组与对照组比较,NOS活性增强,NO₂^-/NO₃^-水平增多。结论:一氧化氮不仅参与肺的生理过程,而且在LIR后急性肺损伤(ALI)病理生理过程中可能发挥重要作用。     

核因子-κB激活与细胞凋亡在重症急性胰腺炎肺损伤中的作用

目的:探讨重症急性胰腺炎(SAP)大鼠肺组织中核因子-κB(NF-κB)活化及细胞凋亡与肺损伤的关系.方法:SD大鼠随机分为对照组、SAP组、二硫代氨基甲酸吡咯烷(PDTC)预处理组.建立各组模型后取肺组织行光镜和电镜下病理观察,免疫组织化学观察NF-κB的表达,TUNEL法观察细胞凋亡情况.结果:对照组细胞结构基本正常,仅极少量NF-κB活化,且只有少量肺泡间质细胞和肺泡上皮细胞凋亡.SAP组可见Ⅱ型肺泡上皮细胞及血管内皮细胞有线粒体肿胀、基膜增宽、核染色质边集、间质水肿、电子密度升高等病理改变.NF-κB表达及细胞凋亡指数均明显升高,并呈动态变化,6h达高峰,NF-κB表达及凋亡细胞主要见于中性粒细胞、单核/巨噬细胞、支气管黏膜上皮细胞、肺泡上皮细胞及部分血管内皮细胞.PDTC预处理组病理改变减轻,NF-κB表达及细胞凋亡指数均明显下降,但仍高于对照组.结论:SAP时肺组织NF-κB活化并通过诱导细胞凋亡参与肺损伤.PDTC可能通过抑制NF-κB活性及细胞凋亡,对肺损伤具有保护作用.     

移植骨髓间充质干细胞减轻脂多糖诱导的小鼠急性肺损伤

目的 观察移植骨髓间充质干细胞 （MSCs） 对脂多糖 （LPS） 诱导小鼠急性肺损伤 （ALI）的治疗修复作用。方法 全骨髓培养法培养小鼠骨髓MSCs;细胞免疫化学染色鉴定MSCs特异表面标记;小鼠咽后壁吸入LPS制造小鼠肺损伤;尾静脉注射引入MSCs;称重计算肺水肿指数;肺组织切片HE染色观察组织病理改变;ELISA检测肺泡灌洗液和肺组织匀浆中IL-1β含量;Brdu（5-Bromo-2-Deoxyuridine）标记供体MSCs,免疫组织化学染色及双染色观察移植细胞的迁移和分化状态。结果 培养的MSCs细胞表面标记CD44阳性,而造血系表面标记CD34阴性。吸入LPS后,小鼠出现典型的肺损伤病理改变,肺水肿指数和肺组织匀浆IL-1β含量明显增加。标记的MSCs移植入同种异体的肺损伤小鼠,其肺部出现标记的MSCs,并表达上皮细胞标志抗原-细胞角蛋白（CK）。治疗后小鼠的肺水肿指数和肺组织匀浆IL-1β含量下降。结论 外源性MSCs移植到肺损伤小鼠体内,可迁移至肺损伤部位,并表达上皮细胞标志;减轻肺水肿程度,减少炎症因子释放。     

Pathological findings after right lung transplantation in a patient with fibrosing alveolitis

The pathological findings in a patient who died two months after right lung transplantation for fibrosing alveolitis are reported. The cause of death was haemoptysis, due to penetrating ulceration causing a fistula between the surface of the cartilagenous part of the main bronchus of the donor lung and the right upper lobe pulmonary artery. The opening in the donor bronchus was immediately distal to the line of the bronchial anastomosis and through an actively inflamed area. Other parts of the donor bronchus had microscopic changes suggesting ischaemia, emphasizing that inadequacy of blood supply to the donor extrapulmonary bronchus is one of the most serious hazards of lung transplantation. Within the lung, histological features of rejection were mild and there was minimal evidence of infection. Another question raised by this case is whether the donor lung was in the process of developing the original disease, evidence for which was sought electron microscopically but was not proven.     

Cellular chimerism of the lung after transplantation. An interphase cytogenetic study

The present study evaluated the origin of endothelial and epithelial cells, as well as of lymphocytes and macrophages, after lung transplantation. Biopsy specimens from patients who underwent lung and heart-lung transplantation and received organs of sex-mismatched donors were studied by means of nonisotopic in situ hybridization with DNA probes of the X and Y chromosome. By means of monoclonal antibodies against leukocytes, T and B lymphocytes, and macrophages, the various infiltrating cell types were analyzed. In all allografted lungs, the endothelial cells and bronchial and alveolar epithelium retained the donor sex type. The lymphocytes of the donor were almost completely replaced by recipient cells 1 month after transplantation. Low numbers of alveolar macrophages of the donor were present during the entire period under study. Low numbers of donor lymphocytes and high numbers of donor alveolar macrophages in the allografted lung seem to be correlated with a worse clinical course.     

Hyperbaric oxygen treatment reduced the lung injury of type II decompression sickness

Objective: To detect the ultrastructural changes in rabbits with type II decompression sickness (DCS), and study the therapeutic effects of hyperbaric oxygen (HBO). Methods: Twenty-seven male New Zealand rabbits were randomly divided equally into the DCS group, HBO treatment group and control group. Experimental models of each group were prepared. Lung apex tissues were harvested to prepare paraffin- and EPON812-embedded tissues. Results: In the DCS group, macroscopic and histological examination revealed severe and rapid damage to lung tissue. Ultrastructural examination revealed exudation of red blood cells in the alveolar space. Type I alveolar epithelial cells exhibited retracted cell processes and swollen mitochondria, and type II cells showed highly swollen mitochondria and decrease in cytoplasmic lamellar bodies. Dilatation and congestion of capillary vessels were accompanied by swelling of endothelial cells and incomplete basement membrane. In the HBO treatment group, the findings were somewhat similar to those in the DCS group, but the extent of damage was lesser. Only a small amount of tiny bubbles could be seen in the blood vessels. Type I alveolar epithelia cells and endothelial cells of the capillaries illustrated slight shortening of cells, swollen cytoplasm and decreased cell processes. Type II alveolar epithelial cells showed slight swelling of the mitochondria, decreased vacuolar degeneration of lamellar bodies, and increase in the number of free ribosomes. Conclusions: Our microscopic and ultrastructural findings confirm that the lung is an important organ affected by DCS. We also confirmed that HBO can alleviate DCS-induced pulmonary damage.     

无心跳供体肺移植中部分液体通气对肺保护的病理学评估

背景：如何在热缺血期给予无心跳供体肺提供保护进而降低移植后原发性移植物失功能是所有研究者和临床医生面前的首要问题。 目的：从病理学角度评价部分液体通气在无心跳供体肺移植中对供体肺的保护作用。 方法：将36只清洁级SD大鼠随机均分为3组,应用自制16G深静脉留置针作气管插管,行气管切开并连接至呼吸机行机械通气。经颈静脉注入KACL溶液猝死大鼠,用多导生理检测仪连续记录血压,在血压变为0 mm Hg时,认为造模成功,模型建立后氧气组大鼠继续给予机械通气2 h;盐水组和氟化碳组先给予盐水和氟化碳5 min的纯氧通气,后从气管插管中注入相当于功能残气量的高氧盐水和高氧氟化碳(10 mL/kg),并给予机械通气2 h。 结果与结论：大体观察盐水组肺脏肿胀,肺组织表面片状出血,肺呈暗红色,气道内有血性水肿液;氧气组见肺脏肿胀较轻,肺表面有少量出血点;氟化碳组肺组织炎症细胞浸润和组织水肿明显减轻。光镜下盐水组和氧气组呈弥漫性肺泡和间质充血、水肿,支气管壁及毛细血管周围有大量的炎性细胞浸润和肺泡过度膨胀,肺泡壁断裂;氟化碳组肺组织细胞结构较为完整,无明显破坏。结果可见部分液体通气可以对无心跳供肺起到很好的保护作用。     

Response of mouse lung to crocidolite asbestos. 2. Pulmonary fibrosis after long fibres

To determine the cellular and fibrogenic responses of the lung to long asbestos fibres, mice were instilled intratracheally with 0.1 mg of a sample of long crocidolite fibres. Animals were killed at intervals to 20 weeks with 3H thymidine injected one h before death. Following bronchoalveolar lavage, an increase in polymorph neutrophils (PMN) and alveolar macrophages (AM) was found during the first week, accompanied by elevated glucosaminidase and alveolar protein levels. Although the PMN number dropped, some were always recovered by lavage to 20 weeks. Early multifocal necrosis of bronchiolar epithelium was followed by a large increase in labelling of epithelial cells and underlying fibroblasts. Epithelial overgrowth of luminal long fibres and inflammatory exudates was followed by giant cell and granuloma formation in the interstitium. After four weeks collagen levels were significantly increased and fibrosis was seen in these peribronchiolar locations. A few small fibres were observed in AM but no evidence of fibrosis was seen in alveolar walls. These findings suggest that injury to bronchial and bronchiolar epithelium allows long fibres to reach the interstitium where subsequent macrophage-fibroblast interactions result in a severe fibrotic reaction that resembles the bronchiolar component of human asbestosis.     

模拟失重大鼠肺组织显微结构和一氧化氮合酶表达的动态变化

目的 观察模拟失重对大鼠肺组织显微结构及其一氧化氮合酶(NOS)表达的影响,为模拟失重时肺组织的适应机制研究积累资料.方法 采用Wistar雄性大鼠-30°尾部悬吊模拟失重生理效应.常规光镜和免疫组织化学方法 观察悬吊7 d组(TS7)、14 d组(TS14)及对照组(Con)肺组织显微结构和结构型NOS(cNOS)、诱导型NOS(iNOS)表达.结果 TS7组大鼠出现肺实变、肺水肿、支气管黏膜内淋巴细胞浸润、肺泡内有红细胞及肺泡融合.TS14组大鼠肺病变较TS7组大鼠明显加重,表现为肺泡融合增多、肺泡内更多红细胞和肺泡壁增厚.各组大鼠肺组织cNOS表达区域主要为支气管上皮细胞、血管内皮细胞和平滑肌细胞,各组间表达水平无统计学差异.iNOS表达在TS7、TS14组血管内皮细胞和平滑肌细胞表达显著增多,其中TS14组血管内皮细胞表达量高于TS7组.结论 模拟失重大鼠肺组织形态学变化可能与肺循环iNOS表达增加有关.     

Pathways of cellular efflux and particulate clearance after carbon instillation to the lung

The pulmonary response to the deposition of carbon particles was investigated to determine the routes of cellular efflux and the mechanisms of particulate clearance. At intervals to 6 months after the intratracheal instillation of 4 mg carbon, the lungs of mice were fixed in situ by perfusion without lavage. Within a few hours, migration of granulocytes into the bronchioles was observed; large numbers of PMNs were not seen in alveoli until 24 h. Associated with the PMN efflux there was transient oedema with no evidence of pulmonary cell necrosis. The number of free macrophages increased in response to the carbon and mononuclear cell migration into alveoli and bronchioles was also observed. The bronchiolar component of the cellular efflux indicates that PMNs and macrophages recovered from the lung by lavage are not entirely of alveolar origin. Whereas most particles, either free or in phagocytic cells, were cleared by the bronchial tree, some transepithelial passage of free particles to the interstitium was observed. Some carbon was found in hilar lymph nodes but overall lymphatic clearance was low.     

人脐带间充质干细胞移植治疗急性肺损伤

BACKGROUND:Studies have shown that human umbilical cord mesenchymal stem cells can improve pulmonary ventilation function by reducing inflammations. OBJECTIVE:To observe the therapeutic effect of human umbilical cord mesenchymal stem cell transplantation on acute lung injury. METHODS:Thirty Sprague-Dawley rats were randomized into normal group, model group and experimental group. Rats in the latter two groups were used to establish animal models of acute lung injury by intratracheal instillation of lipopolysaccharide. One hour after modeling, rats in the experimental group were intratracheally administered human umbilical cord mesenchymal stem cell suspension (0.1 mL, 1×10⁶ cells), and those in the other two groups were given normal saline in the same dose intratracheally. Twenty-four hours after treatment, the pathological changes of lung tissue were observed using hematoxylin-eosin staining; the wet and dry weight ratio of the lung tissue and the levels of serum interleukin-1 and interleukin-8 were detected. RESULTS AND CONCLUSION:Compared with the normal group, the wet and dry weight ratio of the lung tissue and the levels of serum interleukin-1 and interleukin-8 were significantly increased in the model group (P < 0.05), while compared with the model group, these levels were significantly decreased in the experimental group (P < 0.05). Hematoxylin-eosin staining results showed clear alveolar space structure with complete alveolar septum in the normal group. In the model group, the alveolar septum was markedly thickened, and there was visible pulmonary capillary hyperemia, edema, as well as a large amount of inflammatory cell infiltrations in the pulmonary capillaries and alveolar space. Edema fluid rich in proteins was observed in a part of the pulmonary alveoli, and an extensive transparent membrane formed in the alveolar space. In the experimental group, the alveolar structure was clear, but the alveolar septum became thickened, and red blood cells and a small amount of infiltrated inflammatory cells were leaked from the pulmonary interstitial tissue. In conclusion, human umbilical cord mesenchymal stem cell transplantation for treatment of acute lung injury can reduce inflammatory factor levels and alleviate lung injury.     

hnRNP B1 expression in benign and malignant lung disease

Evidence is accumulating to suggest that hnRNP B1 expression may be a useful tool in the early diagnosis of lung cancer. This study examined the immunohistochemical expression of hnRNP B1 in archived sections of resected lung cancers and compared the patterns of expression with those seen in similar archived sections of non-neoplastic lung. Particular attention was paid to the expression of hnRNP B1 in the benign bronchial cells in both cases, to establish if overexpression of this protein in respiratory epithelial cells is specific for malignancy. Nineteen cases of different types of non-small cell carcinoma were examined (eight squamous cell, six adenocarcinomas, two carcinosarcomas, two undifferentiated large cell carcinomas, and one mucoepidermoid carcinoma) and compared with sections from 16 open lung biopsies (three cases of cryptogenic fibrosing alveolitis, two cases of sarcoidosis, two cases of organizing pneumonia, and one case each of tuberculosis, extrinsic allergic alveolitis, non-specific interstitial pneumonitis, pneumocystis pneumonia, aspergilloma, respiratory bronchiolitis-interstitial lung disease, mineral dust disease, Sj?gren's syndrome and systemic sclerosis vascular variant). All the tumours showed positive staining, with the vast majority, 16/19 (84%), showing strong diffuse nuclear staining. The background cells of these cases showed positive staining in alveolar macrophages, lymph node germinal centres, bronchial mucous glands, and bronchial epithelial cells. No significant difference was seen in the percentage of positive bronchial epithelial cells in bronchi adjacent to the tumour compared with the resection margins. In the benign lung cases, positive bronchial epithelial cells were seen in a small percentage, 3/16 (18%), of cases, but the majority of cases showed no or very focal staining. The levels of expression between benign epithelial cells of malignant cases, compared with benign, showed a significant difference when the staining was assessed in percentage of positive nuclei (p = 0.001, Fisher's exact test). The results confirm that hnRNP B1 is widely expressed in a range of lung carcinomas; that expression is seen in benign bronchial epithelial cells and inflammatory cells; and that expression in background bronchial epithelial cells appears to be higher in malignant than in benign lung disease. It is feasible that this biomarker may be of use in the detection of early lung cancer, provided that levels of expression can be accurately quantified.