肾移植术后人卡氏肺囊虫肺炎细胞超微结构研究

目的：深入了解卡氏肺囊虫的超微结构及其所致肺炎的超微病理特点。方法：取29例肺活检组织进行电镜观察。结果：29例活检组织中发现卡氏肺囊虫感染25例，支气管和肺泡的腔内可见各期的卡氏肺囊虫，细支气管、终末细支气管上皮细胞的纤毛或微绒毛脱落比较明显，线粒体空泡变性，内质网扩张，可见细胞坏死脱落现象。肺泡上皮细胞内多数线粒体、内质网及部分Ⅱ型上皮细胞板层小体空泡变性。板层小体数量有所减少，并可见上皮细胞坏死脱落现象。支气管间质和肺泡隔内有炎症细胞漫润，以吞噬细胞为主，胶原纤维不同程度增生。可见囊虫呈结节样或团状充满细支气管或肺泡腔。结论：人卡氏肺囊虫不仅可与支气管或肺泡上皮细胞紧密接触或直接侵入细胞体内对细胞进行直接伤害，还可能通过释放某些活性物质或代谢物对细胞进行伤害，尤其是线粒体、内质网、板层小体等膜性系统发生空泡变性，并引起肺间质胶原纤维增生和阻塞性病变。

Study on the cellular ultrastructure of human pneumonitis caused by pneumocystis carinii after renal transplantation

Objective: Deeply to comprehend the ultrastructure of pneumocystis carinii and microphathologic behaviour of the pneumonitis caused by pneumocystis. Methods: Twenty-nine lung biopsy tissues were observed with electron microscope. Results:Twenty-five cases were infected with pneumocystis carinii. Pneumocystis carinii at different stage was found in the cavum of hronchiae or alveoli. Exfoliation of the cilia and microvilli on the epithelia cells in the bronchioles and terminal bronchioles was more obvious. Vacuolar degeneration in mitochondria, distension in the endoplasmic reticulum and the cellular necrosis and exfoliation were found in the bronchioles and the terminal bronchioles. Majority of mitochondria, endoplasmic retieulum in the alveolar epithelia and vacuolar degeneration in a portion of II model epithelial cells ply corpuscles were seen. The amounts of ply corpuscle were reduced and the necrosis and exfoliation of the epithelia were noticed. In the bronchial interstitial and the alveolar septum, there were some infiltration of the inflammatory cells, in which the phagocytes were the principal infiltranve cells and the hyperplasia in varying degrees was found in collagen fibers. The cavities of bronchiole or alveolus were filled with node-like or mass-like pneumocystis carinii. Conclusion: Not only pneumocystis carinii closely contacts with the bronchial and alveolar epithelial cells and directly invades into the cellular body to damage the epithelia, but also possibly injures the cells, especially the vacuolar degeneration is found in the membranous system, such as mitochondriae, endoplasmic reticula and ply corpuscles, etc., through releasing some active matter or metabolite, and induces hyperplasia of the collagen fibers in the pulmonary interstitial and occlusive lesion.