Luo Ben-fang, Li Hui-ping, Yi Xiang-hua, Tao Ju-wei, Lü Han-jing, Fang Xia, Zhang Zong-mei, Zhang Long, Ren Sheng-xiang, Chu Hai-qing, Li Xia, Zeng Yu
Department of Special Examination, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China.
Zhonghua Jie He He Hu Xi Za Zhi. 2012 Dec;35(12):887-91.
To investigate the ultrastructural features of sputum deposition (SD) and its value in the diagnosis of pulmonary alveolar proteinosis (PAP).
Seven patients with PAP diagnosed by lung biopsy and cytology were enrolled in this study. The patients consisted of 5 men and 2 women, whose median age was 48 years (range 36 to 73). SD and bronchoalveolar lavage fluid (BALF) sediment were made into ultrathin sections and observed under transmission electron microscope (TEM), respectively. Seven cases of control group composed of 4 men and 3 women whose median age was 49 years (range 39 to 68) including 3 cases of bacterial pneumonia, two cases of COPD and 2 cases of exudative pulmonary tuberculosis. Each SD was made into ultrathin section, and compared with the experimental group.
In PAP group, Periodic acid-schiff (PAS) staining was performed on 7 sputum smears and none of them was tested positive for any components with diagnostic interest. Four cases from the 7 paraffin-embed sections of BALF sediment by microscopic examination suggested PAP. Under TEM, BALF sediment showed that many lamellar bodies existed in and outside alveolar epithelial cells, and 5 specimens were consistent with PAP diagnosis. Compared with BALF sediment, SD had apparent degeneration with more myelin phagosomes in the cytoplasm of macrophages, more lamellar bodies in alveolar epithelial cells, and lots of lamellar bodies in the shape of concentric circle in the extracellular spaces. Four from the 7 SD samples were consistent with the diagnosis of PAP. No significant difference was found between SD and BALF in the diagnosis of PAP by electronic examination (P > 0.05). In the 7 cases of control group no drifting osmiophilic lamellar bodies in extracellular space were detected.
The osmiophilic lamellar bodies with diagnostic value were found in SD and BALF of patients with PAP. TEM of SD in combination with clinical manifestations and radiologic findings can make a definitive diagnosis of PAP, especially for those patients who have contraindications to lung biopsy and lung lavage.
探讨痰液沉积（SD）的超微结构特征及其在肺泡蛋白沉积症（PAP）诊断中的价值。
本研究纳入7例经肺活检和细胞学检查确诊为PAP的患者。患者包括5名男性和2名女性，中位年龄为48岁（范围36至73岁）。将SD和支气管肺泡灌洗（BALF）沉淀物制成超薄切片，分别在透射电子显微镜（TEM）下观察。对照组7例，包括4名男性和3名女性，中位年龄为49岁（范围39至68岁），其中3例为细菌性肺炎，2例为慢性阻塞性肺疾病（COPD），2例为渗出性肺结核。将每个SD制成超薄切片，并与实验组进行比较。
在PAP组中，对7份痰涂片进行过碘酸希夫（PAS）染色，均未检测到具有诊断意义的任何成分呈阳性。7份BALF沉淀物石蜡包埋切片中，4份经显微镜检查提示为PAP。在TEM下，BALF沉淀物显示肺泡上皮细胞内外存在许多板层小体，5份标本符合PAP诊断。与BALF沉淀物相比，SD有明显退变，巨噬细胞胞质中有更多髓鞘样吞噬体，肺泡上皮细胞中有更多板层小体，细胞外间隙有许多同心圆状板层小体。7份SD样本中有4份符合PAP诊断。电子检查在PAP诊断中SD与BALF之间未发现显著差异（P>0.05）。对照组7例未在细胞外间隙检测到嗜锇性板层小体。
在PAP患者的SD和BALF中发现了具有诊断价值的嗜锇性板层小体。SD的TEM检查结合临床表现和影像学表现可对PAP做出明确诊断，尤其适用于那些有肺活检和肺灌洗禁忌证的患者。
