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1、远程病理诊断在中国的落地与实践Implementation and practice of remote pathological diagnosis in China 猪事安（杭州）技术服务有限公司猪事安（杭州）技术服务有限公司 安玉甫安玉甫 2022 2022年年1010月月2020日日 内容提要Executive Summary 背景Introduction 研究目的Objectives 材料和方法Materials and methods 结果与分析Results and analysis 结论In conclusion 在中国In China背景Introduction 在加拿大In

2、 Canada背景Introduction 国内没有正规的病理医生培养计划，也没有像国外一样的全功能诊断室提供病理医生的工作环境，所以国内缺真正的兽医病理医生。There is no formal training plan for pathologists in China,and there is no full-function diagnostic room like in foreign countries to provide a working environment for pathologists,so there is a shortage of real veterina

3、ry pathologists in China.背景Introduction 通过远程病理诊断，接受更专业的病理诊断服务。Receive more professional pathological diagnosis services through remote pathological diagnosis.研究目的Objectives材料和方法Materials and methods 取材2*2*2cm左右大小的组织Take the tissue of about 2*2*2cm size材料和方法Materials and methods 固定于10%福尔马林溶液Fixed in

4、10%formalin solution材料和方法Materials and methods 做好病理切片，扫描通过网络发送至北美病理医生。The pathological slides are prepared,and the scans are sent to North American pathologists through the Internet.优点：能接受更专业的病理报告解读。Advantages:More professional pathology report interpretation.结果与分析Results and analysis 案例1：Case 1检出感染

5、detection infection肺脏大体无病变，荧光定量PCR检测PRRSV含量为1.0E+05拷贝/uL，Ct值25.20；组织病理学中，肺脏未见明显的病理损伤。The lungs were generally free of lesions,the PRRSV content detected by fluorescence quantitative PCR was 1.0E+05 copies/uL,and the Ct value was 25.20;no obvious pathological damage was found in the lungs in histopat

6、hology.结果与分析Results and analysis 案例1：Case 1检出感染detection infection在PCR阳性然而无明显病理学变化的情况下，猪可能还在受母源抗体的保护，或者PCR检测出的是疫苗毒。In the case of PCR-positive but no obvious pathological changes,pigs may still be protected by maternally derived antibodies or PCR-detected vaccine virulence.结果与分析Results and analysis

7、案例2：Case 2感染 发病 infection disease 保育45天龄左右仔猪，临床症状咳嗽流鼻涕，剖检病变肺脏肉样变，荧光定量PCR检测SIV含量为6.0E+03拷贝/uL，Ct值28。The 45-day-old piglets were nursed,with clinical symptoms of cough and runny nose,and necropsy examination of the lesioned lungs with sarcoidosis.The SIV content detected by fluorescence quantitative P

8、CR was 6.0E+03 copies/uL,and the Ct value was 28.结果与分析Results and analysis 案例2：Case 2感染 发病 infection disease 组织病理学：气管内有中等量嗜中性粒细胞浸润，病变提示细菌感染；小片区域肺泡内有坏死巨噬细胞团块，病变提示PRRS。Histopathology:moderate infiltration of neutrophils in the trachea,lesions suggestive of bacterial infection;small areas of alveolar c

9、lumps of necrotic macrophages,lesions suggestive of PRRS.结果与分析Results and analysis 案例3：排除和确诊同等重要 Case 3：To rule out is as important as to diagnose出生1-2日龄仔猪突发死亡，死亡前表现为：四肢划水、神经症状、部分出现吐奶现象。Piglets at 1-2 days old died suddenly.Before the death,the piglets showed as follows:watering on the limbs,neurolo

10、gical symptoms,and some spitting up.出生1-2日龄仔猪突发死亡，死亡前表现为：四肢划水、神经症状、部分出现吐奶现象。结果与分析Results and analysis 案例3：Case 3现场剖检：肺脏水肿疑似白色坏死灶，心肌变硬，肝脏边缘黑色，胃黏膜出血，脑部充血。On-site autopsy:pulmonary edema with suspected white necrosis,myocardium hardening,liver border black,gastric mucosal bleeding,and brain congestion.

11、结果与分析Results and analysis 案例3：Case 3PCR：伪狂犬gE阴性。PCR:Pseudorabies gE gene test was negative.病理：肾小管上皮细胞严重水泡样变，肝小叶中央细胞空泡变性。Pathology:severe vesicular degeneration of renal tubular epithelial cells and vacuolar degeneration of central hepatic lobule cells.结果与分析Results and analysis 案例3：Case 3经济效益分析：检测费用3

12、000元，总价值损失253000元。Economic benefit analysis:The testing cost is 3,000 yuan,and the total value loss is 253000 yuan.结果与分析Results and analysis 案例3：Case 3 PCR及病理检测都排除了伪狂犬的感染，有神经症状死亡的初生仔猪并不一定都是伪狂犬。病变符合药物中毒现象，即药物主要残留于肝脏和肾脏，且主要由肾脏清除的特点。Both PCR and pathologic examination ruled out the infection of PRV,and

13、 the newborn piglets with neurological symptoms were not necessarily PRV.The lesion is consistent with drug poisoning since the drug in question is mostly cleared through the kidney and liver.结果与分析Results and analysis 案例4：Case 4 注意用多种方法验证一个诊断Use more than one method to confirm a diagnosis 浙江某猪场，出生7天

14、龄仔猪拉稀，部分出现血便，死亡率超过15%。On a pig farm in Zhejiang,7-day-old piglets had diarrhea,some had bloody stools,and the mortality rate exceeded 15%.结果与分析Results and analysis 案例4：Case 4 现场剖检：肠道出血，胃粘膜出血，脾脏梗死，肾脏出血点。On-site necropsy:intestinal bleeding,gastric mucosal bleeding,spleen infarction,renal bleeding poi

15、nts.结果与分析Results and analysis 案例4：Case 4 PCR：猪流行性腹泻病毒、猪传染性胃肠炎和轮状病毒阴性。PCR:porcine epidemic diarrhea virus,porcine transmissible gastroenteritis,and rotavirus were negative.结果与分析Results and analysis 案例4：Case 4 PCR：蓝耳病毒和猪瘟病毒阴性。PCR:negative for PRRS virus and swine fever virus.结果与分析Results and analysis

16、案例4：Case 4病理：严重粘膜坏死，坏死底部有大量细菌。毛细血管里的血栓。Histopathology:Severe mucous membrane necrosis,necrosis at the bottom of a large number of bacteria.A clot in a capillary.结果与分析Results and analysis 案例4：Case 4 病变符合A型魏氏梭菌引起的坏死性肠炎，加上PCR排除了病毒性腹泻的可能，A型魏氏梭菌是最可能的病原。The pathological changes were consistent with necrot

17、izing enteritis caused by clostridium westerwelle A,and the possibility of viral diarrhea was ruled out by PCR,clostridium westerwelle A was the most likely pathogen.肠道病料随后送至国内某高校做了厌氧培养，也证实了是A型魏氏梭菌。The intestinal disease material was then sent to A domestic university for anaerobic culture,which als

18、o proved to be clostridium wilsinensis type A.注意用多种方法验证一个诊断Use more than one method to confirm a diagnosis结果与分析Results and analysis 案例4：Case 4 经济效益分析：检测费用4000元，总价值损失77600元。Economic benefit analysis:The testing cost is 4,000 yuan,and the total value loss is 77600 yuan.结果与分析Results and analysis 缺点Disa

19、dvantages 时间周期长，需要5-10天。Time to spend 5-10 days.结果与分析Results and analysis 病理学诊断是与其他实验室诊断配合的有力诊断工具。Pathological diagnosis is a powerful diagnostic tool in conjunction with other laboratory diagnoses.病理诊断是中国动物健康系统所缺的一块拼图。Pathological diagnosis is the missing piece of the puzzle in Chinas animal health system.结论In conclusionTHANK YOU猪事安（杭州）技术服务有限公司PIG PEACE(Hangzhou)Technical Service Co.,Ltd.福建卫祥畜牧发展有限公司Fujian Weixiang Animal Husbandry Development Co.,Ltd.福建九为生物技术有限公司Fujian Jiuwei Biotechnology Co.,Ltd.