Erokhin V V, Gedymin L E, Zemskova S, Lepekha L N, Podolianko P N
Probl Tuberk. 2001(7):50-5.
The morphological features of caseous pneumonia (CP) were studied in 90 patients aged 20-54 years by using specimens obtained at autopsy and surgery at the Central Research Institute of Therapy, Russian Academy of Medical Sciences and Moscow Clinical Tuberculosis Hospital No. 7. Thirty patients died from CP, 30 were operated on for CP. A matched group of 30 patients was operated on for fibrocavernous pulmonary tuberculosis (FCPT). Of the 30 patients operated on for CP, the process was classified as an individual nosological entity in 19 patients and as a complication due to FCPT in 11 patients. Out of the 30 deceased, CP was as an individual nosological entity in 17 patients and it complicated acute FCPT in 13 patients. Morphological (light and electron microscopy) and immunomorphological studies revealed the specific features of CP, which distinguished it from other forms of pulmonary tuberculosis. These included: the fulminant course and dissemination of lung tissue lesion, which is association with the appearance of intravascular blood coagulation and lung infarction; 2) development of immunodeficiency in the presence of autoallergy to the basilar membrane of lung vessels, macrophageal and lymphocytic dysfunctions; 3) extensive cell dystrophy of the air-blood barrier even in the intact portions of the lung; 4) hepatic dysfunction due to extensive dystrophy to the extent of hepatocytic micronecroses and dyscirculatory disorders.
在俄罗斯医学科学院中央治疗研究所和莫斯科第七临床结核病医院，对90名年龄在20至54岁之间的患者进行尸检和手术获取的标本，研究了干酪性肺炎（CP）的形态学特征。30名患者死于CP，30名患者接受了CP手术。一组匹配的30名患者接受了纤维空洞型肺结核（FCPT）手术。在接受CP手术的30名患者中，19例患者的病情被归类为个体疾病实体，11例患者的病情被归类为FCPT的并发症。在30名死亡患者中，17例患者的CP为个体疾病实体，13例患者的CP并发急性FCPT。形态学（光学和电子显微镜）和免疫形态学研究揭示了CP的特异性特征，使其与其他形式的肺结核区分开来。这些特征包括：1）肺组织病变的暴发性病程和播散，这与血管内凝血和肺梗死的出现有关；2）在对肺血管基底膜存在自身过敏、巨噬细胞和淋巴细胞功能障碍的情况下出现免疫缺陷；3）即使在肺的完整部分，气血屏障也出现广泛的细胞营养不良；4）由于广泛的营养不良导致肝细胞微坏死和循环障碍，进而出现肝功能障碍。
