大骨节病患儿外周血白细胞的病理学研究——揭示大骨节病病毒血症的形态学证据

目的 大骨节病(KBD)病因至今未明.本文做KBD患儿外周血白细胞的病理学研究拟验证KBD发病中有病毒血症的假设.方法 在病区小学,临床粗筛出KBD疑似儿童82例(经X线片检出KBD患儿65例),光镜查其外周血血涂片后,从中选出有白细胞病变者10例,以电镜寻找其白细胞内的病毒体. 结果 光镜查出外周血白细胞病变阳性者64/82例,可疑阳性者7/82例.电镜下,在9/10例白细胞内检出病毒核衣壳.衣壳直径70～100 nm,外形六角,部分有小核心.核衣壳外围见细胞核染色质溶解灶. 结论 在9/10例白细胞核内有病毒核衣壳的结果,使KBD发病中有病毒血症的假设得到验证.该病毒引发出白细胞坏死过程是具有细胞病变效应的.该病毒可能也是KBD软骨细胞坏死的原因.KBD病儿外周血白细胞坏死的病理学发现将对血液病理学有一定的参考意义.

Pathological Study on White Blood Cells in Peripheral Blood of Children with Kashin-Beck Disease

Objective Because the cause of Kashin-Beck disease(KBD) is still uncertain,a pathological study on white blood cells in peripheral blood of the children with KBD was undertaken to validate the hypothesis that there may be viremia in KBD pathogenetic process.Methods At the primary school in the endemic area,82 children were roughly screened out for suspected suffering from KBD by clinical examination.After the peripheral blood smears of the cases were observed under light microscope,the 10 cases with lesions in white blood cells were selected for further search of viruses,by electron microscope,in the white blood cells.Results The positive pathological changes in white blood cells were present in 64 out of 82 cases,and the suspected positives in 7 out of 82 cases were ascertained through light microscope.By using electron microscope,nucleocapsids in the nucleuses of white blood cells were found in 9 out of 10 cases.The nucleocapsids had a diameter of 70-100 nm,their shapes were hexangular,and a portion of them contained small cores.The dissolving focuses surrounding the nucleocapsids were found in the nucleus chromatins.Conclusions The hypothesis that there is virusemia in the pathogenetic process of KBD has been verified through the result that viral nucleocapsids inside nucleuses of white blood cells in 9 out of 10 cases are present.The virus has induced necrotic process of white blood cell and it is possessing cytopathic effects.The virus may be also the cause of cartilage cell necrosis in KBD.It would have some reference value to hematopathology that pathological changes on the necrotic process of white blood cells in peripheral blood of children with KBD were found out.