SARS患者尸检肺组织的TGF-β检测

为了研究TGFβ1在严重急性呼吸综合征(Severeacuterespiratorysyndrome,SARS)尸检肺组织中的表达情况及其在患者肺组织损伤中的可能作用,对2例SARS尸检肺组织进行病理学观察;应用免疫组化方法检测TGFβ1在尸检肺组织及对照肺组织中的表达情况,并进行半定量分析。结果显示病例一尸检肺组织主要病理改变为弥漫性肺泡损伤,透明膜形成及渗出性炎症。病例二尸检肺组织除了上述改变外,还伴有肺泡间质纤维增生和肺泡早期纤维化等机化性肺炎改变。TGFβ1平均灰度值在SARS患者肺组织为103.43±0.62;小叶性肺炎组织为131.47±2.64;正常肺组织中为144.24±0.09。3组比较有显著差别(P值<0.05)。SARS病毒感染后可引起急性肺间质和肺泡渗出性炎症,中后期病例还伴有肺泡间质纤维增生和肺泡早期纤维化;SARS患者肺组织损伤及纤维化与SARS冠状病毒感染后TGFβ1表达增强有关,提示抗TGFβ1治疗在SARS患者肺损伤、纤维化的预防、治疗过程中可能具有一定的临床意义。     

SARS患者尸检肺组织的TGF-β检测

为了研究TGF-β1在严重急性呼吸综合征(Severe acute respiratory syndrome, SARS)尸检肺组织中的表达情况及其在患者肺组织损伤中的可能作用,对2例SARS尸检肺组织进行病理学观察;应用免疫组化方法检测TGF-β1在尸检肺组织及对照肺组织中的表达情况,并进行半定量分析. 结果显示病例一尸检肺组织主要病理改变为弥漫性肺泡损伤,透明膜形成及渗出性炎症.病例二尸检肺组织除了上述改变外,还伴有肺泡间质纤维增生和肺泡早期纤维化等机化性肺炎改变.TGF-β1平均灰度值在SARS患者肺组织为103.43±0.62;小叶性肺炎组织为131.47±2.64;正常肺组织中为144.24±0.09.3组比较有显著差别(P值＜0.05).SARS病毒感染后可引起急性肺间质和肺泡渗出性炎症,中后期病例还伴有肺泡间质纤维增生和肺泡早期纤维化;SARS患者肺组织损伤及纤维化与SARS冠状病毒感染后TGF-β1表达增强有关,提示抗TGF-β1治疗在SARS患者肺损伤、纤维化的预防、治疗过程中可能具有一定的临床意义.     

严重急性呼吸综合征(SARS)患者不同组织中冠状病毒的分离和鉴定

严重急性呼吸综合征(SARS)自2002年11月在中国广东爆发后,已迅速蔓延成为全球性传染疾患。为了了解SARS冠状病毒的特征,对先前SARS冠状病毒PCR检测呈阳性的来自广东的3份尸检肺组织标本、2份尸检脾组织标本：来自北京的2份咽拭子标本和1份血清标本,利用10种不同的细胞系分离病毒。结果显示,上述标本在感染细胞后,分别可在293、Vero—E6、Vero、RD和HeLa细胞系中产生细胞病变(CPE)。不同标本在上述细胞系中致CPE的能力不同,但CPE出现的时间和病变形态学特征无显著性差异。以恢复期SARS病人血清为抗体,用间接免疫荧光法对感染后细胞培养的检测,冠状病毒RT-_PCR对感染后细胞RNA的检测,初步证明分离的病毒为冠状病毒。结果再次证明冠状病毒为SARS的病原,它具有较广泛的器官分布和细胞感染能力。血清中SARS冠状病毒的分离,高度提示在SARS发病过程中存在有病毒血症。     

从SARS患者血清发现双相型深部真菌的报告

目的从临床诊断的SARS病人血清中分离病原微生物。方法采用SARS患者血清通过NIH小鼠腹腔、脑和鸡胚卵黄囊和尿囊接种、人胚肺细胞呼吸道病毒培养和系列细菌培养分离病原体,所获微生物经形态学、血清学、生化学和法国梅里埃(Vitek)全自动微生物系统鉴定,复制动物模型和病理学检查。结果从SARS病人血清分离的微生物,检定结果为一种双相型深部嗜肺性真菌,属流行性肺组织胞浆菌(球状酵母菌)。结论分离的肺组织胞浆菌(球状酵母菌)是呼吸系统深部真菌。     

内蒙地区发热患者血清中冠状病毒抗体的检测

目的分析内蒙地区发热患者中冠状病毒的感染情况。方法以SARS冠状病毒感染Vero细胞涂片为冠状病毒抗原片,用间接免疫荧光法分别检测55例发热患者和68例正常人血清中冠状病毒的IgG、IgM抗体。结果发热患者血清中冠状病毒IgG抗体和IgM抗体阳性率分别为29.1%(16/55)和10.9%(6/55),而正常人血清中只检测到2.9%(2/68)的IgG抗体,且未检测到IgM抗体,2组患者的IgG和IgM抗体阳性率比较差异均有显著性;随机选取7例患者的IgG阳性血清进行SRAS冠状病毒的特异性抗体封闭实验,结果有6例血清仍为阳性,有1例血清转为阴性,说明冠状病毒IgG抗体阳性血清中85.7%为普通冠状病毒特异性,14.3%为SARS冠状病毒特异性。结论普通冠状病毒是内蒙地区发热患者的主要病原体之一,部分患者还存在SARS冠状病毒的既往感染。     

SARS冠状病毒分离培养和鉴定的实验研究

建立严重急性呼吸综合征(SARS)冠状病毒分离、培养方法,为SARS冠状病毒动物模型的建立提供实验依据,并根据病毒在体内存活的时间确定检测指标。选用已鉴定为SARS冠状病毒的毒株,经过鼻腔接种感染恒河猴。定期采集咽拭子标本,分离血清或血浆,用Vero细胞进行病毒培养、分离。结果显示,在SARS冠状病毒感染恒河猴后2、5、7天,可以从拭子中分离到病毒,5～15天可在猴肺、脾、肝、肾和淋巴组织中分离到病毒,并用免疫荧光法和RT-PCR方法进行了确定。首次实验证实了SARS冠状病毒可在恒河猴体内复制。SARS病毒的成功分离是SARS冠状病毒动物模型建立的主要依据,在进行疫苗安全性和药效评价等工作中,病毒分离可作为药物筛选、疫苗评价的重要指标。     

SARS冠状病毒的分离培养与鉴定

采集急性期病人的咽拭子或漱口液,用Vero 、Vero E6、MDCK、Hela 、Hep-2等传代细胞,人胚肺二倍体细胞(HEL)和人胚肺(HP)细胞分离培养严重急性呼吸系统综合症(SARS)的病原体.结果用Vero、Vero E6、MDCK和HP细胞从标本中分离到一株病毒.间接免疫荧光试验发现,恢复期病人血清可与所分离的病毒起反应,在胞膜和胞浆中出现翠绿色荧光;中和试验结果表明,恢复期病人血清能中和病毒对细胞的致细胞病变作用;电镜下可观察到冠状病毒样颗粒;RT-PCR法可扩增到冠状病毒特异性基因片段,且其核苷酸序列与国内外发表的SARS冠状病毒(SARS-Cov)相应的基因序列相符,同源性达到100%.从传染性非典型肺炎病人的漱口液中分离到SARS冠状病毒,这种病毒与传染性非典型肺炎密切相关.     

SARS冠状病毒N蛋白激活hfgl2凝血酶原酶基因的研究

研究鉴定激活hfgl2凝血酶原酶基因的SARS冠状病毒结构蛋白。从SARS尸检肺组织中抽提RNA后制备cDNA,分别扩增SARS-CoV的N、S2和M全长基因序列,再分别克隆到真核表达载体pcDNA3.1( )上。应用免疫组织化学分析鉴定pcDNA3.1-N、pcDNA3.1-M和pcDNA3.1-S2的表达。构建人纤维介素(hfgl2)启动子荧光素酶报告基因质粒,并将SARS冠状病毒结构蛋白表达质粒分别与其共转染以明确激活hfgl2基因转录的SARS冠状病毒结构蛋白。将目的片段克隆至pcDNA3.1( ),经酶切鉴定和测序鉴定无误;免疫组织化学染色可见明显的CHO细胞胞浆棕染。与hfgl2启动子共转染实验阐明SARS冠状病毒膜(M)蛋白和刺突糖(S2)蛋白对hfgl2基因的激活与对照组无显著差异,而SARS冠状病毒核心(N)蛋白可激活hfgl2启动子,使其转染活性提高4.6倍。SARS冠状病毒N蛋白可增强hfgl2基因的转录活性。     

SARS冠状病毒的分离培养与鉴定

采集急性期病人的咽拭子或漱口液,用Vero、Vero E6、MDCK、Hela、Hep-2等传代细胞,人胚肺二倍体细胞(HEL)和人胚肺(HP)细胞分离培养严重急性呼吸系统综合症(SARS)的病原体。结果用Vero、Vero E6、MDCK和HP细胞从标本中分离到一株病毒。间接免疫荧光试验发现,恢复期病人血清可与所分离的病毒起反应,在胞膜和胞浆中出现翠绿色荧光;中和试验结果表明,恢复期病人血清能中和病毒对细胞的致细胞病变作用;电镜下可观察到冠状病毒样颗粒;RT-PCR法可扩增到冠状病毒特异性基因片段,且其核苷酸序列与国内外发表的SARS冠状病毒(SARS-Cov)相应的基因序列相符,同源性达到100％。从传染性非典型肺炎病人的漱口液中分离到SARS冠状病毒,这种病毒与传染性非典型肺炎密切相关。     

在传染性非典型肺炎患者组织和血液中发现冠状病毒

用RT-PCR从广东两例传染性非典型肺炎(非典型肺炎)死亡病例的肺和脾标本中,以及北京、辽宁和宁夏非典型肺炎患者血清中,扩增出冠状病毒核苷酸序列。这些PCR产物为冠状病毒RNA聚合酶基因部分片段,所有测定的序列和国内外SARS病毒序列相同。这些发现提示,冠状病毒和非典型肺炎关系密切,有助于确定我国非典型肺炎的病因。所建立的套式PCR方法可以用于检测临床标本。由于血液中存在SARS病毒,进行血清操作时需要注意安全保护。     

Pathology of guinea pigs experimentally infected with a novel reovirus and coronavirus isolated from SARS patients

Guinea pigs were inoculated with a reovirus (ReoV) and coronavirus (SARS-CoV) isolated from SARS patients to determine their potential role in the etiology of SARS. Animals infected with ReoV died between day 22 and day 30 postinoculation (PI) while 70% of the animals inoculated with ReoV and SARS-CoV died between day 4 to day 7 PI. The titer of neutralizing antibodies against ReoV and SARS-CoV ranged from 80 to 160 when the animals were inoculated with the two viruses, respectively, while the titer of the antibodies was just below 10 in coinfections. The animal inoculated with ReoV developed diffuse alveolar damage similar to the exudative and leakage inflammation found in SARS patients, and was characterized by diffuse hemorrhage, fibroid exudation, hyaline membrane formation, and type II pneumocytes hyperplasia in alveolar interstitia. The pulmonary epithelial necrosis, excoriation, and early fibrosis of pulmonary tissue were only observed in ReoV-SARS-CoV groups and in SARS-CoV/ReoV groups. Other typical pathological changes included hemorrhagic necrosis in lymph nodes and spleen and hydropic degeneration in the liver. On the contrary, guinea pigs infected with SARS-CoV only developed interstitial pneumonitis. Our experiment demonstrate that ReoV might be one of the primary causes of SARS, since simultaneous coinfection can duplicate the typical pathological changes similar to that of SARS patients. This guinea pig model may provide a useful animal model for SARS.     

Cytokine responses in porcine respiratory coronavirus-infected pigs treated with corticosteroids as a model for severe acute respiratory syndrome

The effectiveness and potential immunosuppressive effects of anti-inflammatory glucocorticoids in the lungs of severe acute respiratory syndrome (SARS) patients are undefined. We treated porcine respiratory coronavirus (PRCV)-infected conventional pigs with the corticosteroid dexamethasone (DEX) as a model for SARS. Innate and Th1 cytokines in bronchoalveolar lavage (BAL) and serum were elevated in PRCV-infected pigs compared to controls, but were decreased after DEX treatment in the PRCV-infected, DEX-treated (PRCV/DEX) pigs. Although decreased in BAL, Th2 cytokine levels were higher in serum after DEX treatment. Levels of the proinflammatory cytokine interleukin-6 in BAL and serum were decreased in PRCV/DEX pigs early but increased later compared to those in phosphate-buffered saline-treated, PRCV-infected pigs, corresponding to a similar trend for lung lesions. PRCV infection increased T-cell frequencies in BAL, but DEX treatment of PRCV-infected pigs reduced frequencies of T cells; interestingly B and SWC3a(+) (monocytes/macrophages/granulocytes) cell frequencies were increased. DEX reduced numbers of PRCV-stimulated Th1 gamma interferon-secreting cells in spleen, tracheobroncheolar lymph nodes, and blood. Our findings suggest that future glucocorticoid treatment of SARS patients should be reconsidered in the context of potential local immunosuppression of immune responses in lung and systemic Th1 cytokine-biased suppression.     

Association of sinus histiocytosis with massive lymphadenopathy and idiopathic hypereosinophilic syndrome

A patient was evaluated because of edema, pruritus and generalized painless lymphadenopathy. Laboratory tests showed marked eosinophilia without known etiology. CT scan of abdomen revealed multiple lymph nodes in retroperitoneal area. Lymph node biopsy was reported as sinus histiocytosis, bone marrow biopsy showed hypercellularity with marked infiltration of normal eosinophils. During his admission he developed Coombs positive hemolytic anaemia. Once he was stable, a laparotomy was performed and the patient died two days later because of septic shock. Autopsy revealed sinus histiocytosis with massive lymphadenopathy (SHML) with extranodal involvement of duodenum, spleen and prostate; septic liver and spleen, pyelonephritis, marked infiltration of eosinophils in lymph nodes, spleen, liver duodenum and lungs. To the best of our knowledge, this is the first case report of the association of SHML and Idiopathic Hypereosinophilic Syndrome (HES).     

Establishment of a reference panel for the detection of anti-SARS-CoV antibodies.

The immunological assays for detection of antibodies against SARS-CoV were developed in-house and some of them are available commercially. However, the antigens used in these assays differed. In order to validate the reliability of these assays, the standard panel should be established. In this study, we have expressed and purified severe acute respiratory syndrome (SARS) structural proteins and their fragments and developed indirect enzyme-linked immunosorbent assays (ELISAs) that detect antibodies against the SARS N, N(1), N(2), S(1), S(C), S(2), and M proteins as well as the human coronavirus OC43 and 229E N proteins. These assays were used to screen 58 samples from SARS convalescent patients, 40 serial serum specimens from patients at different phases of SARS infection, and 88 plasma specimens from normal blood donors. The samples from normal blood donors were also tested for antibodies against other respiratory virus. The representative samples were chosen to comprise a reference panel of SARS antibodies that may be used for the detection of SARS. The panel is composed of 25 positive samples, 25 negative samples, 7 diluted samples for anti-N antibody, 6 diluted samples for anti-S antibody, and one sample for validating precision. Comparison of detection results with different SARS antibody assays indicated that our panel should differentiate the specificity and sensitivity of different assays.     

Identification of a new human coronavirus

Three human coronaviruses are known to exist: human coronavirus 229E (HCoV-229E), HCoV-OC43 and severe acute respiratory syndrome (SARS)-associated coronavirus (SARS-CoV). Here we report the identification of a fourth human coronavirus, HCoV-NL63, using a new method of virus discovery. The virus was isolated from a 7-month-old child suffering from bronchiolitis and conjunctivitis. The complete genome sequence indicates that this virus is not a recombinant, but rather a new group 1 coronavirus. The in vitro host cell range of HCoV-NL63 is notable because it replicates on tertiary monkey kidney cells and the monkey kidney LLC-MK2 cell line. The viral genome contains distinctive features, including a unique N-terminal fragment within the spike protein. Screening of clinical specimens from individuals suffering from respiratory illness identified seven additional HCoV-NL63-infected individuals, indicating that the virus was widely spread within the human population.     

SARS冠状病毒感染恒河猴的病毒、血清学检测研究

[目的]对感染SARS-CoV的恒河猴进行病毒、血清学等指标检测及研究,确定模型动物成功感染,并为SARS发病机制,疫苗评价,药物筛选确定参考指标。[方法]SARSCo-V经鼻腔接种8只恒河猴,在感染的第1天开始到5、7、10、15、20、30和60天分别安乐死时,不同时间取咽拭子、血液和脏器,进行病毒分离,RT-PCR检测和抗体测定。[结果]用巢式RT-PCR在感染后每天提取的咽拭子标本中检测SARS-CoV的RNA,以细胞培养冠状病毒为阳性对照,以正常恒河猴咽拭子为阴性对照,在8只动物病毒接种第5天开始可检测到大小为797bp的目的条带,阳性检出最长可持续到第15天。进一步用病毒分离实验对PCR结果进行确证,8只动物中的5只恒河猴接种5天的咽拭子标本中,经Vero细胞培养,细胞产生了典型细胞病变(CPE),提示SARS冠状病毒能感染恒河猴并有病毒的复制和排毒。IFA方法证实为SRAS-CoV抗原存在。SARS-CoV感染恒河猴后,可以检测出免疫反应。在SARS冠状病毒接种前和接种后第5、8、11、15、19、23、26、30、34、每隔4-7天以及安乐死时采血,制备血清测定抗体,8只恒河猴接种病毒前均血清中SARS冠状病毒特异性抗体IgG为阴性,10天后安乐处死的5只感染猴在11-15天开始,至安乐死时,均为阳性。IgG阳性的5只恒河猴均有一定的中和抗体产生,且对SARS病毒感染细胞有一定的保护性。感染SARS病毒猴后与正常猴比较,其细胞杀伤效应明显增强。感染SARS-CoV的恒河猴不仅出现与SARS患者类似的临床和病理学改变,也在一定时期内排毒,出现特异免疫反应,这些指标均可作为药物筛选、疫苗评价等方面的重要参数。     

Systemic infection with Alaria americana (Trematoda).

Alaria americana is a trematode, the adult of which is found in mammalian carnivores. The first case of disseminated human infection by the mesocercarial stage of this worm occurred in a 24-year-old man. The infection possibly was acquired by the eating of inadequately cooked frogs, which are intermediate hosts of the worm. The diagnosis was made during life by lung biopsy and confirmed at autopsy. The mesocercariae were present in the stomach wall, lymph nodes, liver, myocardium, pancreas and surrounding adipose tissue, spleen, kidney, lungs, brain and spinal cord. There was no host reaction to the parasites. Granulomas were present in the stomach wall, lymph nodes and liver, but the worms were not identified in them. Hypersensitivity vasculitis and a bleeding diathesis due to disseminated intravascular coagulation and a circulating anticoagulant caused his death 8 days after the onset of his illness.     

肿瘤患者血清中SARS-CoV抗体阳性原因分析

探讨SARS冠状病毒(SARS—CoV)抗体在SARS病原学诊断中的特异性及其在肿瘤患血清中的假阳性问题。应用ELISA和荧光定量RT-PCR技术检测了111例正常对照和40例肿瘤患血清中SARS—CoV抗体的阳性率。在111例正常对照中,IgM抗体均阴性,IgG抗体的阳性率为3．6％(4／111);IgG抗体诊断SARS的特异性为96．4％,两种抗体同时阳性诊断SARS的特异性为100％。40例肿瘤患中,IgM抗体均阴性,IgG抗体阳性率17．5％(7／40)。经RT—PCR检测,上述肿瘤患阳性病例均为阴性。结果表明,同时测定SARS—CoV的两种抗体可降低诊断的假阳性率,提高诊断的特异性。用非纯化SARS—CoV抗原制备的ELISA试剂盒测定肿瘤患的SARS—CoV抗体,可能出现假阳性。在肿瘤患中出现假阳性的原因可能与包被的抗原有关。     

Biliary adenocarcinoma in a stranded northern elephant seal (Mirounga angustirostris)

A stranded adult female northern elephant seal (Mirounga angustirostris) was admitted to a rehabilitation hospital grossly underweight and lethargic in April 2001. The animal was icteric, had severe bilirubinemia, and elevated serum gamma glutamyl transferase concentrations. Laparoscopy under anesthesia revealed multiple masses up to 3 cm diameter throughout the liver and spleen and the animal was euthanized. Abnormal gross postmortem findings included green serous fluid in the abdominal cavity and 0.5 to 3 cm diameter yellow nodules scattered throughout the liver, spleen, and lymph nodes. Histopathology revealed a biliary adenocarcinoma with metastases to the liver, spleen, lymph nodes, adrenal gland, and pancreas. This is believed to be the first reported case of neoplasia in a northern elephant seal.