尸检工作举例

尸检工作的消退，目前对我国病理学发展可能起瓶颈作用。如新兵分析，原因是复杂的，提高尸检重要性的认识可能起一定作用。下面展示J一此图片，举了一个用尸检材料阐明我国重要传染病” 肾综合征出血热或流行性出血热”病理学及发病学的例子。(刘彦伤,杨守京)

Our Reaserches in the Pathology and Pathogenesis of Helorrhagic Fever with Renal Syndrome  我们对肾综合征出血热病理学及发病学的研究

Section 1:Distinguish Primary change and Secondary change

第一节  首先区别了原发性病变及继发性病变

Primary change  Single scattered cell necrosis or apoptosis . Direct effect of virus or immunocomplex.

原发性病变: 单个分散的细胞坏死或凋亡,由于病毒或免疫复合物的作用.

Secondary change: Large area of infarct-like necrosis due to ischemia. hypotension.or shock.

继发性病变: 大面积梗死样坏死,由于休克.低血压.组织缺血所致

1-1  Death of Purking cell of human cerebellum.cell body shrinked with red cytoplasm and pyknotic nucleus, coagulation or apoptosis,primary change (Autopsy H.E)

1-1. 人小脑浦顷野氏细胞凋亡,胞体收缩,胞浆红染,胞核浓缩(小→)附近细胞无死亡(粗→) 原发性病变. (尸检H.E)

1-2  Swellon liquefactive necrotic cerebral pyremadal  cell with vacuolated virus NP antigen (Autopsy A25.5PAP)

1-2. 人大脑锥体细胞肿胀,液化性坏死,胞浆中有空泡状颗粒核抗原(尸检 A25.5PAP)

1-3 Neurinophagia necrotic nerve cells of dentate nucleus surrounded by glial cells(Autopsy H.E)

1-3. 嗜节现象,小脑齿状核细胞坏死后为胶质细胞包围(→)(尸检 H.E)

1-4 Large area of ischmic change of neurons Secondary change (autopsy H.E)

1-4 大面炽神经细胞缺血样坏死, 胞体缩小. 胞浆红染 , 继发性病变(尸检 H.E)

1-5 Large area of early softening of cerebrum with proliferation of capillaries and gitter cell formation H.E

1-5.大脑大面积早期软化,示毛细血管增生, 格子细胞形成↓.继发性病变(尸检 H.E)

1-6 large area of softening with gitter cells formation secondary change (Autopsy H.E)

1-6.大片脑软化,格子细胞形成,继发性病变(尸检 H.E)

1-7 Coagulated  scattered cells ,among noneffected cells. Apoptosis of nerve cells in hypocampus of infected suckling mouse (Exp H.E)

1-7凝固的神経细胞,分散在大致正常的细胞之间,患病乳鼠海马,原发性病变(实验 H.E)

1-8 Necrotic cells with virus antigen primary change (Exp)

1-8坏死细胞含病毒抗原, 原发性病变(实验)

1-9 Necrotic cells with virus antigen primary change (Exp)

1-9坏死细胞含病毒抗原, 原发性病变(实验)

1-10 Large area of infarct-like necrotic cerebral cortex beneath the infiltrated meninges,Secondary change一(Exp H.E)

1-10 大面积梗死性病变,脑膜内炎细胞浸润, 继发性病变 (实验 H.E)

1-11 A segment of hypocampus pyrimedal layer shows ischmeic change with pynotic nuclei (Exp.H.E)

1-11.一段海马锥体细胞层细胞,示缺血性变化, 继发性病变 (实验 H.E)

References 有关文章

1．   刘彦仿, 晏培松，李存玺．流行性出血热患者脑内原发性及继发性病变． 中华病理学杂志   1989;18(4):244-246

2．       Liu Yanfang, Li XU-Xi, Yan Peisong. Primary and secondary changes in the brains of sucking BALB/c mice with hemorrhagic fever. Chin Med J 1992;105(11):909-912

3．       刘彦仿等．流行性出血热患者肝脏原发性及继发性病变的研究．医药信息论坛  1992;6(11)

4．       刘彦仿，杨守京，邓平非，晏培松，李青，王彦雪，耿文琴．流行性出血热患者肝脏原发性及继发性病变．中华传染病学杂志  1994;12 (2): 107-107

5．        

Questons 问题

1. Distinction of primary and secondary changes could be frequently found in brain, liver and kidney Necrotic changes were rarely see in orther organs

2．The mechanism of cellular death will be described later

Section-2   Many kinds of cells are target cells

第二节     多种细胞都是靶细胞

2-1 Strong positive antigen was 1st found in macrophages in kidney of an aborted infant (FITC-MAb direct Methed)

2-1首先在早产儿巨噬细胞中发现病毒抗原(FITC-单抗,直接法 肾脏)

2-2 Endothelium was the target cell,trandational idea

2-2传统概念,内皮是唯一的靶细胞

2-3 Hantanvirus 1s trophic to most kinds of cells. Oral stratified sequmaous epithelium  infected by granular antigen with cellular destruction( NP antigen 8F8, 5 PAP)

2-3 汉坦病毒对大多数细胞是多嗜的性.口腔复层鳞状上皮细胞中颗粒性抗原,细胞结构破坏(核抗原8F8单抗,5 PAP法)

2-4 Submucus glands of bronchus with positive antigen

2-4 支氣管粘膜下腺体含较强抗原

2-5 Epithelium of bronchus with positive antigen

2-5 支气管粘膜上皮胞浆中有块状抗原

2-6 Grunalar antigen in lung epithelial cells

2-6.肺泡上皮徊细胞中颗粒性抗原

2-7 Pancratic aciners with positive granular antigen (Hemagglutinin antibody 8D2 5 PAP)

2-7 胰腺腺泡细胞胞浆内颗粒状抗原(血凝素单抗8D2 5 PAP法)

2-8 Epithelium of collecting tubules with positive hemagglutinin antigen(3D8 4 PAP)

2-8. 肾收集管广上皮内的颗粒状血凝素抗原(3D8 4PAP法)

2-9 Granular antigen in liver and kupfer cells

2-9 肝细胞及枯否氏徊细胞中的颗粒性抗硕原

2-10 nerve cells affected by virus antigen (Colloid iron stain Autopsy)

2-10 神経细胞内的绿色抗原（胶体铁染色, 尸检）

2-11 Nerve cells with positive antigen (ABC)

2-11神経细胞内的颗粒抗原(ABC法)

2-12 Bone marrow  cells with positive antigen APAAP stain (Biopsy)

2-12. 骨髓细胞挠抗原阳性，硷性磷酸酶抗硷性磷酸酶法（活检穿刺）

2-13 Smooth  muscle cells of small artery with vacuolated hemaggglutinin antigen (7D1 antibody 4 PAP)

2-13．小动脉壁平滑肌细胞内空泡状颗粒性血凝素抗原 (7D1单抗 4PAP)

2-14 Granular Antigen in adrenal cortex

2-14.肾上腺皮质内颗粒性抗原

2-15 Antigen in thyroid epithelium(G2 antibody LV48A 4PAP+4ABC)

2-15 甲状腺上皮中糖蛋白抗原(G2单抗LV48A 4PAP+4ABC)

2-16 Antigen of RBC mainly in manbrane

2-16. 红细胞抗原,主要在膜上

References 有关文章

1.      Liu YF, Yan PS, Wang PY, Wang NP. Intrauterine infection of epidemic hemorrhagic fever(EHF) via placenta. C M J 1987;100(9):756-758

2.      Liu YF, Yang SJ, Yan PS. Detection of virus antigen of epidemic hemorrhagic fever by multiple repeated PAP and ABC methods and their combination. Acta Anatomia Sinica 1991 suppl 2:21-22

3.      Yang SJ, Liu YF. Modified immuno-colloidal ferric cytochemical staining. Acta anatomia Sinica 1991, supplement 22:2:35-35

4.      杨守京，刘彦仿，刘莹莹．流行性出血热患者超微病理及病毒抗原的免疫细胞化学定位．第四军医大学学报  1992;13(3):161-164

5.      杨守京，刘彦仿，刘莹莹，刘厚才．多重PAP及多重PAP结合ABC免疫细胞化学方法的建立及其敏感性分析与应用．中国组织化学与细胞化学杂志  1993;2(1):42-52

6.      杨守京, 刘彦仿, 晏培松，刘莹莹，刘厚才．应用单克隆抗体免疫细胞化学方法分析尸检组织中肾综合征出血热病毒G2、NP、及HA结构蛋白抗原．中国病毒学  1993;8(3):244-258

7.      杨守京，刘彦仿，刘莹莹，晏培松，徐志凯．肾综合征出血热内分泌组织中的病毒抗原、病变及其关系．第四军医大学学报  1993; 14(6):  405-409

8.      刘彦仿，杨守京，晏培松．流行性出血热病毒颗粒性抗原（包涵体）在人、大鼠及小鼠的形态分布．第四军医大学学报  1994;15(2): 81-85

9.      杨守京，刘彦仿，韩爱萍，徐志凯，晏培松．流行性出血热尸检材料中包涵体的研究  中国病毒学  1992;7(3):246－252

Question问题

1.The expression of antigen is mainly granular by immunohistochemistry. Under electron microscope it shows an inclusion body but why it might assume a bulb form?

b1.免疫组织化学染色病毒抗原多呈粗颗粒状。电镜下抗原呈包涵体状，为什么会呈空泡状？

Section:3  Difference in Virus RNA Distribution in Autopsy tissues between wild and Domestic Types by In Situ Hybridization