Kotler D P, Weaver S C, Terzakis J A
Am J Surg Pathol. 1986 Aug;10(8):531-8. doi: 10.1097/00000478-198608000-00002.
Focal crypt epithelial cell degeneration (apoptosis) of the rectum is a characteristic pathologic feature in AIDS. The presence of apoptosis usually implies cell-mediated cytolysis, which would be an unexpected finding in this disease. We investigated the ultrastructural features of apoptosis in rectal biopsies from five AIDS patients (three homosexual males and two females with i.v. drug abuse), three heterosexual controls, and two homosexual male controls. Apoptosis was found in all AIDS patients and, to a lesser extent, in one heterosexual control. Ultrastructurally, vacuolization of several adjacent cells, leading to extrusion of cellular debris through the basal lamina and phagocytosis by macrophages, was seen. No intracellular or extracellular viral particles were detected in the regions containing apoptotic bodies, in epithelial cells near the crypt bases, in intraepithelial lymphocytes, or in macrophages. In summary, apoptosis in the rectal crypts of patients with AIDS has the same ultrastructural features as in other conditions, which suggests that its pathogenesis is related to immune rather than infectious factors. If this process occurs on a chronic basis in multiple cell types, it would promote general tissue depletion, which has been demonstrated to occur in AIDS. The presence of apoptosis in AIDS is not explained by current concepts of disease pathogenesis.
直肠局灶性隐窝上皮细胞变性（凋亡）是艾滋病的一个特征性病理表现。凋亡的存在通常意味着细胞介导的细胞溶解，而这在该疾病中是一个意外发现。我们研究了5例艾滋病患者（3例同性恋男性和2例静脉注射吸毒女性）、3例异性恋对照者以及2例同性恋男性对照者直肠活检中凋亡的超微结构特征。在所有艾滋病患者中均发现了凋亡，在1例异性恋对照者中也有程度较轻的凋亡。超微结构上，可见几个相邻细胞空泡化，导致细胞碎片通过基膜挤出并被巨噬细胞吞噬。在含有凋亡小体的区域、隐窝底部附近的上皮细胞、上皮内淋巴细胞或巨噬细胞中均未检测到细胞内或细胞外病毒颗粒。总之，艾滋病患者直肠隐窝中的凋亡具有与其他情况相同的超微结构特征，这表明其发病机制与免疫因素而非感染因素有关。如果这个过程在多种细胞类型中慢性发生，将会促进全身组织消耗，这在艾滋病中已得到证实。艾滋病中凋亡的存在无法用当前的疾病发病机制概念来解释。
