Mahidol-Oxford Research Unit, and Department of Tropical Pathology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
Clin Infect Dis. 2012 Apr;54 Suppl 2(Suppl 2):S165-71. doi: 10.1093/cid/cir1062.
The diagnosis of etiology in severe pneumonia remains a challenging area. Postmortem lung tissue potentially increases the sensitivity of investigations for identification of causative pathogens in fatal cases of pneumonia and can confirm antemortem microbiological diagnoses. Tissue sampling allows assessment of histological patterns of disease and ancillary immunohistochemical or molecular diagnostic techniques. It may also enhance the recognition of noninfectious conditions that clinically simulate acute pneumonia. Biobanking of lung tissue or postmortem culture isolates offers opportunities for new pathogen discovery and research into host-pathogen interactions. The Pneumonia Etiology Research for Child Health study proposes a percutaneous needle biopsy approach to obtain postmortem samples, rather than a full open autopsy. This has the advantage of greater acceptability to relatives, but risks greater sampling error. Both approaches may be susceptible to microbiological contamination or pathogen degradation. However, previous autopsy studies have confirmed the value of histological examination in revealing unsuspected pathogens and influencing clinical guidelines for the diagnosis and treatment of future pneumonia cases.
严重肺炎的病因诊断仍然是一个具有挑战性的领域。尸检肺组织有可能提高对致命性肺炎病例中致病病原体的调查的敏感性，并能确认生前微生物学诊断。组织采样可评估疾病的组织学模式，并辅助免疫组织化学或分子诊断技术。它还有可能提高对临床上模拟急性肺炎的非传染性疾病的认识。肺组织或死后培养分离物的生物库为新病原体的发现和宿主-病原体相互作用的研究提供了机会。儿童健康肺炎病因研究建议采用经皮针吸活检方法获取死后样本，而不是进行全面的开放式尸检。这种方法的优点是更能被亲属接受，但存在更大的采样误差风险。这两种方法都可能受到微生物污染或病原体降解的影响。然而，以前的尸检研究证实了组织学检查在揭示未被怀疑的病原体和影响未来肺炎病例的诊断和治疗临床指南方面的价值。
