安俊卿 戴榕全 湯 金 盧 巖 佘銳萍*田紀(jì)景 石蕊寒 常玲玲 張成林*
(1.中國(guó)農(nóng)業(yè)大學(xué)動(dòng)物醫(yī)學(xué)院,北京,100193;2.北京動(dòng)物園,北京,100044)
白眉長(zhǎng)臂猿感染戊型肝炎病毒的病理學(xué)觀察
安俊卿1戴榕全1湯 金1盧 巖2佘銳萍1*田紀(jì)景1石蕊寒1常玲玲1張成林2*
(1.中國(guó)農(nóng)業(yè)大學(xué)動(dòng)物醫(yī)學(xué)院,北京,100193;2.北京動(dòng)物園,北京,100044)
稿件運(yùn)行過程
白眉長(zhǎng)臂猿; 戊型肝炎病毒; 肝炎; 肺炎; 腎炎
2010年3月8日,北京動(dòng)物園1只白眉長(zhǎng)臂猿突發(fā)死亡,通過組織病理學(xué)和免疫組織化學(xué)等方法對(duì)該病死白眉長(zhǎng)臂猿死因進(jìn)行分析。大體剖檢觀察顯示心臟表面可見灰白色病灶,肝臟表面散在大小不一黃白色病灶,腎臟成土黃色,肺臟大面積出血,胃黏膜有散在出血點(diǎn),腸道水腫,腸系膜淋巴結(jié)腫大。病理組織學(xué)觀察結(jié)果顯示心肌壞死嚴(yán)重,肺臟嚴(yán)重出血并含有大量炎性細(xì)胞浸潤(rùn),肝臟肝細(xì)胞變性壞死并有大量的炎性細(xì)胞浸潤(rùn),腎臟腎小管上皮細(xì)胞變性壞死,腎小管管腔中含有黃綠色的小結(jié)晶體,腸黏膜水腫。免疫組織化學(xué)檢測(cè)肝臟、腎臟戊型肝炎病毒ORF 2陽(yáng)性。綜合診斷該白眉長(zhǎng)臂猿因感染戊型肝炎病毒而導(dǎo)致抵抗力減弱,從而導(dǎo)致腎臟腎小管蛋白凝集發(fā)生結(jié)晶,引發(fā)尿毒癥,而后導(dǎo)致心肌壞死,從而導(dǎo)致死亡。
白眉長(zhǎng)臂猿(Hoolockleuconedys)為國(guó)家Ⅰ級(jí)重點(diǎn)保護(hù)動(dòng)物,世界自然保護(hù)聯(lián)盟(IUCN)中規(guī)定為瀕危級(jí)保護(hù)動(dòng)物[1]。白眉長(zhǎng)臂猿分布區(qū)域狹窄,數(shù)量稀少,現(xiàn)已瀕于滅絕。在白眉長(zhǎng)臂猿棲息的高黎貢山,國(guó)家已建立了自然保護(hù)區(qū)。
戊型肝炎(HE)是由戊型肝炎病毒(HEV)引起的一種以糞-口途徑傳播為主的慢性傳染性疾病[2]。戊型肝炎是一種人畜共患傳染病,常通過污染食物和飲水進(jìn)行傳播,孕婦感染后死亡率可達(dá)20%,對(duì)人類的健康產(chǎn)生了極大的危害[3]。目前,戊型肝炎在發(fā)達(dá)及發(fā)展中國(guó)家均被看作為是一種主要的疾病[4],在我國(guó)戊型肝炎的感染率呈逐年遞增的趨勢(shì)。
自從Meng等2003年首次從豬血清分離到豬源戊型肝炎病毒后[5],相繼有學(xué)者報(bào)道牛、犬、兔子和嚙齒類動(dòng)物均可以感染戊型肝炎病毒,戊型肝炎病毒在動(dòng)物中已廣泛存在[6-9]。但對(duì)于圈養(yǎng)野生動(dòng)物戊型肝炎病毒感染的報(bào)道相對(duì)較少,對(duì)于戊型肝炎病毒感染白眉長(zhǎng)臂猿的病例還未見有報(bào)道。白眉長(zhǎng)臂猿和其他長(zhǎng)臂猿一樣,是靈長(zhǎng)類學(xué)家、心理學(xué)家的重要研究動(dòng)物。
本研究通過組織病理學(xué)和免疫組織化學(xué)等方法對(duì)白眉長(zhǎng)臂猿感染戊型肝炎病毒而引起心力衰竭的死亡病例進(jìn)行了報(bào)道,為進(jìn)一步防止此類疾病的發(fā)生,保護(hù)白眉長(zhǎng)臂猿的健康提供借鑒與參考。
1.1 材料
白眉長(zhǎng)臂猿,編號(hào)y 09-2,雌性,2009年到北京動(dòng)物園做繁殖交換,年齡10歲,死前2個(gè)月第一次發(fā)生腹瀉,而后1周化驗(yàn)鞭毛蟲陽(yáng)性,潛血可疑;4 d后稀便化驗(yàn)?zāi)撉蜿?yáng)性,鞭毛蟲包囊陽(yáng)性;4 d后又在稀便中發(fā)現(xiàn)黏液,但無(wú)蟲卵。死前1個(gè)月糞便中發(fā)現(xiàn)大量鞭毛蟲滋養(yǎng)體,其他陰性。而后稀便化驗(yàn)鞭毛蟲陽(yáng)性,死前2周稀便,眼觀明顯黏液,便檢黏液陽(yáng)性,潛血陽(yáng)性,膿球大量,蟲卵陰性。死前10 d出現(xiàn)嘔吐水樣清亮黏液現(xiàn)象,嘔吐物中含有白細(xì)胞少量,扁平上皮細(xì)胞陽(yáng)性,水瀉潛血陽(yáng)性,膿球陽(yáng)性,黏液蟲卵陰性,拍片右盆腔有高亮不規(guī)則陰影。死前1周,稀便中有疑似膽汁的橘黃色液體,潛血陽(yáng)性,內(nèi)有草酸鈣結(jié)晶。死亡當(dāng)天血液生化出重度缺鉀,15:30見腹部脹,呼吸困難,16:00吐鮮血,16:15搶救無(wú)效死亡,死前生化檢驗(yàn),谷丙轉(zhuǎn)氨酶是正常值的3倍。
1.2 方法
取病死金絲猴內(nèi)臟器官于25mL/L戊二醛-多聚甲醛混合液充分固定后,常規(guī)方法成石蠟切片,進(jìn)行HE染色,Mallory三色染色和HEV免疫組織化學(xué)染色(HEV ORF 2抗體,1∶200稀釋,購(gòu)于中杉金橋),重點(diǎn)觀察心臟,肝臟,肺臟,腎臟,脾臟和胃腸道的病理變化。
2.1 大體剖檢觀察結(jié)果
剖檢:尸重8.5 kg。剖檢可見全身脂肪黃染。
主要病變:肺臟眼觀大面積出血,實(shí)變(圖1),支氣管內(nèi)含泡沫狀血性物;肝臟表面凸凹不平,散在大小不一黃白色的病灶(圖2)。腎臟表面色淡褐黃色,切面皮髓界限不明顯,實(shí)質(zhì)呈土黃色(圖3);心臟外觀色淡,表面可見灰白色病灶(圖4);淋巴結(jié)中央髓質(zhì)部呈黑色;胃腸道黏膜面蒼白,胃黏膜面小面積彌散出血點(diǎn),腸道全段水腫,腸壁增厚,腸系膜淋巴結(jié)均腫大,最大約1 cm×1.5 cm(疑似觸診腫物)。
2.2 組織病理學(xué)觀察結(jié)果
2.2.1 心臟:心肌纖維多見波浪狀變化,斷裂,肌纖維普遍腫脹、顆粒變性,局部心肌纖維呈條索狀溶解性壞死,在血管周圍溶解性壞死更明顯。間質(zhì)明顯水腫(圖5,圖6)。
2.2.2 肺臟:肺主要是小葉性化膿性肺炎的變化。鏡下可見,有的小葉出現(xiàn)大面積出血和局灶性嗜中性白細(xì)胞浸潤(rùn),嗜中性白細(xì)胞大多呈破碎狀態(tài)。有的肺小葉呈現(xiàn)代償性支氣管高度代償性擴(kuò)張。細(xì)支氣管和肺泡管內(nèi)常見有炎性細(xì)胞浸潤(rùn)(圖7,圖8,圖9)。
2.2.3 腎臟:皮質(zhì)區(qū):腎小球內(nèi)系膜細(xì)胞增生,基底膜增厚、顯現(xiàn),發(fā)生膜性腎小球腎炎,有的腎小球明顯萎縮。腎球囊內(nèi)常見有粉紅色蛋白顆粒聚集;腎小管上皮發(fā)生玻璃滴樣變,或壞死,很多小管內(nèi)可見黃綠色細(xì)小結(jié)晶。髓質(zhì)腎小管普遍顯著擴(kuò)張(圖10,圖11,圖12)。
2.2.4 肝臟:肝小葉界限分明,肝細(xì)胞中度脂肪變性,胞漿中充滿了空泡,肝小葉周圍的肝細(xì)胞有大量含鐵血黃素沉著。肝呈現(xiàn)在脂肪性變性的基礎(chǔ)上局灶性壞死,有可能由于長(zhǎng)時(shí)間出血形成。匯管區(qū)淋巴細(xì)胞大量浸潤(rùn),局部大片纖維組織增生,迪氏隙顯現(xiàn)水腫(圖13,圖14)。
2.2.5 腸道:腸普遍出血,水腫,血液中嗜酸性粒細(xì)胞增多。結(jié)腸中,黏膜上皮完整,固有層含有大量淋巴細(xì)胞浸潤(rùn)并有含鐵血黃素,腸道中肥大細(xì)胞減少,固有層中可觀察到大量原蟲滋養(yǎng)體狀結(jié)構(gòu)(圖15,圖16)。
2.2.6 淋巴結(jié):腸系膜淋巴結(jié)髓質(zhì)淋巴竇極度擴(kuò)張??梢娡淌捎谐壬Y(jié)晶的巨噬細(xì)胞(圖17),肺門淋巴結(jié)有碳末(圖18)。
2.3 Mallory 三色染色結(jié)果
Mallory三色染色結(jié)果顯示心肌纖維大片溶解性壞死,纖維組織增生,肝臟肝小葉匯管區(qū)大量纖維組織增生(圖19,圖20)。
2.4 肝臟和腎臟HEV免疫組織化學(xué)觀察結(jié)果
HEV免疫組織化學(xué)染色顯示在肝臟有陽(yáng)性信號(hào)彌散分布于肝細(xì)胞的胞漿(圖21,圖22)。在腎臟中,腎小管上皮細(xì)胞的胞漿有陽(yáng)性信號(hào)分布,腎小球呈陰性(圖23,圖24)。
在本病例的病史中闡述,白眉長(zhǎng)臂猿死前有兩月腹瀉的現(xiàn)象,并檢驗(yàn)有鞭毛蟲感染。經(jīng)推測(cè),有可能為賈第鞭毛蟲病。賈第鞭毛蟲經(jīng)食物感染在十二指腸內(nèi)脫囊變成滋養(yǎng)體,在十二指腸壁和膽囊中寄生并繁殖,引起腸炎。賈第蟲高發(fā)于熱帶,對(duì)于健康動(dòng)物感染不明顯[10]。由于此只白眉長(zhǎng)臂猿感染戊型肝炎病毒,從而使自身抵抗力下降,給予了賈第鞭毛蟲生存環(huán)境,所以出現(xiàn)了腹瀉的現(xiàn)象。在腸道的固有層也看到了大量寄生蟲樣物質(zhì)。長(zhǎng)期的腹瀉現(xiàn)象導(dǎo)致了白眉長(zhǎng)臂猿全身代謝紊亂,脫水而導(dǎo)致了腎結(jié)石。
HE染色鏡下觀察心臟心肌纖維嚴(yán)重壞死,Mallory三色結(jié)果顯示心肌纖維大片溶解壞死,大量纖維組織增生,心肌壞死是該白眉長(zhǎng)臂猿的致死原因。腎臟有明顯的蛋白管型和大量的結(jié)晶,根據(jù)病史推斷,這種結(jié)晶可能為草酸鈣結(jié)晶。大量的遠(yuǎn)曲小管結(jié)石堵塞,使腎遠(yuǎn)曲小管極度擴(kuò)張,從而產(chǎn)生尿毒癥,引起心肌發(fā)生嚴(yán)重的變性壞死。肺組織大面積壞死,肺出血嚴(yán)重,有急性化膿性炎癥。肺中組織大量壞死,有出血,大量嗜中性粒細(xì)胞浸潤(rùn),并有濃汁形成。肺炎及肺的大面積出血壞死導(dǎo)致缺氧也是心肌壞死的原因之一。心肌壞死是引起白眉長(zhǎng)臂猿死亡的直接因素。
HEV 作為一種人畜共患傳染病病原,已受到國(guó)內(nèi)外學(xué)者的廣泛關(guān)注。現(xiàn)已證實(shí)豬、牛、禽類和嚙齒類動(dòng)物等動(dòng)物均可感染戊型肝炎病毒,戊型肝炎在動(dòng)物中已廣泛存在[11-14]。作為一種食源性傳染病病原,HEV感染食物的情況也受到了廣泛的關(guān)注[15-16]。由于HEV 在人畜之間的極大危害性,目前對(duì)HEV的致病機(jī)理及其感染后對(duì)全身各器官的損傷的研究也已有相應(yīng)的報(bào)道[17-19]。
隨著HEV宿主的不斷擴(kuò)大,其對(duì)圈養(yǎng)野生動(dòng)物的影響開始受到學(xué)者的重視。通過對(duì)動(dòng)物園圈養(yǎng)野生動(dòng)物HEV流行病學(xué)調(diào)查,發(fā)現(xiàn)在哺乳動(dòng)物和禽類中均可檢測(cè)到HEVPCR陽(yáng)性[20]。Li Heng等曾報(bào)道過HEV和真菌混合感染圈養(yǎng)高山兀鷲(Gypshimalayensis)的病例,說(shuō)明HEV在動(dòng)物園中的流行狀況已受到了學(xué)者的廣泛關(guān)注[21]。本課題組丁葉等曾對(duì)戊型肝炎病毒感染大熊貓(Ailuropodamelanoleuca)后其肝臟和腎臟的組織病理學(xué)變化做了相應(yīng)報(bào)道[22]。石蕊寒等曾用免疫組化對(duì)北京動(dòng)物園5例靈長(zhǎng)類動(dòng)物戊型肝炎進(jìn)行過調(diào)查,結(jié)果表明5例病例的肝臟和腎臟免疫組化染色均呈現(xiàn)不同程度的陽(yáng)性反應(yīng),從而表明在一定程度上北京動(dòng)物園靈長(zhǎng)類動(dòng)物存在HEV感染[23]。而白眉長(zhǎng)臂猿感染HEV的病例還未見有報(bào)道。
本研究中病死白眉長(zhǎng)臂猿大體剖檢顯示肝臟表面凹凸不一,肝臟表面有大小不一的黃白色病灶,病理組織學(xué)觀察結(jié)果顯示肝外周顏色明顯變淺,肝中含鐵血黃素沉著明顯,匯管區(qū)纖維化增生,肝細(xì)胞呈現(xiàn)不同程度變性、壞死,匯管區(qū)炎性細(xì)胞浸潤(rùn),間質(zhì)中有少量的淋巴細(xì)胞浸潤(rùn),Mallory三色染色結(jié)果顯示肝小葉匯管區(qū)纖維增生,呈現(xiàn)慢性肝炎癥狀。
大體剖檢圖片
圖1 肺臟大面積出血Fig.1 Large area of lung hemorrhage
圖2 肝臟表面凸凹不平,散在大小不一黃白色病灶Fig.2 The surface of the liver was uneven and scattered with different sizes of yellow white lesions
圖3 腎臟切面皮髓界限不明顯,實(shí)質(zhì)呈土黃色Fig.3 The boundary of renal cortex and medulla was not obvious, and the color of parenchyma was khaki
圖4 心臟外觀色淡,表面可見灰白色病灶Fig.4 The color of the heart was light and there are white lesions on the surface
圖5 心肌纖維腫脹,呈波浪狀(HE,20×)Fig.5 Myocardial fibers were swollen and waved(HE,20×)
圖6 心肌纖維大片溶解性壞死(HE,20×)Fig.6 Most of the myocardial fibers were dissolved necrosis(HE,20×)
圖7 肺實(shí)質(zhì)大面積出血,嗜中性白細(xì)胞浸潤(rùn)(HE,20×)Fig.7 Massive areas of the lung parenchyma were hemorrhage and infiltration of neutrophils(HE,20×)
圖8 高倍鏡觀察,肺出血和嗜中性白細(xì)胞浸潤(rùn)(HE,40×)Fig.8 In the high magnification microscopy,the lung was hemorrhage and neutrophil infiltration(HE,40×)
圖9 支氣管高度代償性擴(kuò)張,局部肺泡代償性擴(kuò)張(HE,20×)Fig.9 The bronchus were highly compensatory expansion and local alveolars were compensatory expansion(HE,20×)
圖10 腎臟腎小管普遍發(fā)生玻璃性樣變,腎小管管腔中有蛋白管型(HE,20×)Fig.10 Hyaline degeneration was commonly occurred in the renal tubular and protein cast could be observed in the renal tubules(HE,20×)
圖11 腎小管中??梢婞S綠色細(xì)小結(jié)晶,有的結(jié)晶呈圓形或扇形(HE,40×)Fig.11 Small yellow green crystals could be seen in the tubules,some of which are round or shaped(HE,40×)
圖12 腎臟腎球囊明顯擴(kuò)張,囊腔中有粉紅色蛋白滲出物,腎小球嚴(yán)重萎縮(HE,40×)Fig.12 The Kimmelstiel was significantly expanded,and there was a pink protein exduation in the glomerular cavity.The glomerular was atrophy severely(HE,40×)
圖13 肝小葉界限分明,肝小葉周圍的肝細(xì)胞有大量含鐵血黃素沉著(HE,10×)Fig.13 The boundary of the acini hepatitis is clear and there is a large number of hemosiderosis around the hepatic cells(HE,10×)
圖14 匯管普遍淋巴細(xì)胞浸潤(rùn)(HE,40×)Fig.14 Lymphocyte cells infiltration in the portal area(HE,40×)
圖15 腸黏膜固有層及黏膜下明顯水腫紅色為潘氏細(xì)胞(↑)(HE,40×)Fig.15 Intestinal lamina and submucosal layer was edema.The red was Paneth Cells(↑)(HE,40×)
圖16 腸黏膜固有層中有炎性細(xì)胞浸潤(rùn)(HE,40×)Fig.16 Inflammatory cell infiltration in the lamina of the intestine(HE,40×)
圖17 腸系膜淋巴結(jié)髓質(zhì)淋巴竇極度擴(kuò)張有吞噬橘紅色結(jié)晶的巨噬細(xì)胞(HE,20×)Fig.17 Medullary lymph sinus of the mesenteric lymph nodes were enlargement severely.Macrophages with orange red crystals could be observed(HE,20×)
圖18 肺門淋巴結(jié)有大量碳末沉著(HE,40×)Fig.18 A large number of carbon can be observed in Hilar lymph node(HE,40×)
圖19 心肌纖維大片溶解壞死,纖維組織增生(藍(lán)色)(Mallory 三色染色,20×)Fig.19 Most of myocardial fibers were necrosis and fibrous tissue were proliferation(blue)(Mallory three color stain,20×)
圖20 肝小葉匯管區(qū)大量纖維組織增生(藍(lán)色)(Mallory三色染色,20×)Fig.20 Proliferation of fibrous tissue in the portal area (blue)(Mallory three color stain,20×)
圖21 肝臟中HEV陽(yáng)性信號(hào)廣泛分布(HEV免疫組化,10×)Fig.21 Positive HEV signals distribute widely in the liver (HEV immunohistochemistry,10×)
圖22 肝細(xì)胞胞漿呈強(qiáng)陽(yáng)性反應(yīng)(HEV免疫組化,20×)Fig.22 Strong positive signals in the hepatic cell cytoplasm (HEV immunohistochemistry,20×)
圖23 腎小管上皮普遍呈HEV陽(yáng)性反應(yīng)(HEV免疫組化,20×)Fig.23 HEV positive signals widely distribute in renal tubular epithelium(HEV immunohistochemistry,20×)
圖24 HEV陽(yáng)性信號(hào)分布于腎小管上皮細(xì)胞胞漿及管腔滲出物中(HEV免疫組化,40×)Fig.24 HEV positive signals distribute in renal tubular epithelial cell cytoplasm and luminal exudates(HEV immunohistochemistry,40×)
由于取材時(shí)未能及時(shí)凍存新鮮組織,很遺憾沒有PCR診斷結(jié)果,但有報(bào)道顯示免疫組織化學(xué)染色同樣是診斷HEV感染的重要方法之一[24]。HEV免疫組織化學(xué)染色顯示在其肝臟、腎臟中有陽(yáng)性信號(hào)彌散分布于肝細(xì)胞的胞漿及腎小管上皮細(xì)胞的胞漿中。這表明病死白眉長(zhǎng)臂猿感染了HEV,上述肝臟的病理變化與HEV感染有關(guān)。而其死前的生化檢查中,谷丙轉(zhuǎn)氨酶是正常值的三倍,進(jìn)一步驗(yàn)證了此病例白眉長(zhǎng)臂猿患有嚴(yán)重的肝炎。
目前,人畜共患傳染性疾病感染圈養(yǎng)珍稀野生動(dòng)物的情況越來(lái)越受到人們的重視。圈養(yǎng)動(dòng)物生活環(huán)境被污染,飼養(yǎng)管理方式不當(dāng),都會(huì)造成機(jī)體抵抗力下降、傳染性疾病的傳播,從而產(chǎn)生巨大的經(jīng)濟(jì)損失。因此,對(duì)我們應(yīng)當(dāng)重視對(duì)HEV等一系列食源性傳播的病原,保持動(dòng)物園環(huán)境衛(wèi)生,做好相關(guān)生物安全防護(hù)工作,嚴(yán)格衛(wèi)生管理制度,以保障白眉長(zhǎng)臂猿等圈養(yǎng)珍稀野生動(dòng)物的安全。
從此病例的發(fā)病經(jīng)過及其大體剖檢病變來(lái)看,此例白眉長(zhǎng)臂猿因感染HEV,導(dǎo)致其抵抗力下降,引起賈第蟲感染,以至長(zhǎng)期腹瀉,使全身代謝平衡紊亂。尤其是腎小管廣泛的結(jié)石的存在,導(dǎo)致體內(nèi)代謝產(chǎn)物排泄受阻,引起尿毒癥,繼而造成大片心肌壞死,是引起此例長(zhǎng)臂猿死亡的主要原因。而其肺部的化膿性炎,是導(dǎo)致其死亡的誘發(fā)因素。
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Hylobates hoolock; Hepatitis E virus; Hepatitis; Pneumonia; Nephritis
Observation of the Pathology of Hepatitis E VirusInfection inHoolockleuconedys
An Junqing1Dai Rongquan1Tang Jin1Lu Yan2She Ruiping1*Tian Jijing1Shi Ruihan1Chang Lingling1Zhang Chenglin2*
(1.College of Veterinary Medicine,China Agricultural University,Beijing,100193,China;2.Beijing Zoo,Beijing,100044,China)
On 8 March 2010,aHoolockleuconedysdied suddenly at Beijing Zoo.We conducted histopathology and immunohistochemistry to analyze the cause of death.Gross autopsy showed white lesions on the surface of the heart and different sizes of yellow-white lesions on the surface of the liver.The kidney became soil yellow and severe hemorrhage was found in the lung.There were scattered bleeding spots in the stomach mucous membrane.The intestine showed edema and the mesenteric lymph node was dilated.Per the results of histopathology,the myocardium showed severe necrosis.Many inflammatory cell infiltrations were discovered together with severe pulmonary hemorrhage in the lung.Examination of the liver revealed degeneration,necrosis and inflammatory cell infiltration.Large numbers of tubular epithelial cells were degenerative and obvious yellow green crystals were found in the renal tubes.The intestinal mucosal showed edema.Immunohistochemistry results revealed that HEV ORF 2 antigen was positive in the liver and kidney.Per these results,we established that infection of hepatitis E virus in the Hylobates hoolock caused weakened resistance resulting from protein agglutination in renal tubes which induced crystallization uremia.Finally,myocardial necrosis was severe and led to the death of the gibbon.
Figures of gross lesions
安俊卿,男,24歲,碩士研究生;中國(guó)農(nóng)業(yè)大學(xué)動(dòng)物醫(yī)學(xué)院病理與公共衛(wèi)生研究室。E-mail:904345922@qq.com
*通訊作者:佘銳萍,E-mail:sheruiping@126.com;張成林,E-mail:zhch6465@263.net
2016-09-28
S859.8
A
修回日期:2016-10-18
發(fā)表日期:2017-02-10
2310-1490(2017)01-115-07