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目的 研究严重急性呼吸综合征 (SARS)的病理学特征及临床治疗的病理学基础 ,并探讨SARS的发病机制。方法 采用光、电镜观察 ,对 2例SARS系统尸检病例和 4例多器官多部位穿刺标本进行病理学观察 ;应用免疫组化标记并分析肺组织及免疫器官中各淋巴亚群的分布及数量变化 ;核酸原位杂交结合电镜观察 ,作SARS冠状病毒 (SARS CoV)在体病原学定位及定量检测。结果 6例SARS肺组织均呈弥漫性肺泡上皮损伤 ,2例尸检肺组织呈急性间质性炎和区域性肺水肿 ,2例尸检和1例穿刺肺组织中肺泡腔内透明膜形成 ,1例尸检和 2例穿刺肺组织呈脱屑性终末细支气管炎及肺泡炎 ,2例穿刺病例见早期肺纤维化及肺泡腔机化。SARS肺外器官 ,2例病程 <12dSARS病例免疫器官呈较广泛的出血坏死性炎 ,组织细胞及单核细胞样免疫母细胞反应性增生 ,骨髓组织内单核 粒细胞系统相对抑制 ,而 4例病程 >2 1dSRAS病例脾脏中央动脉周围T淋巴细胞增生 ,骨髓像大致正常。体内SARS CoV存在多种感染靶细胞和靶器官 ,其中肺脏为主要靶器官 ,支气管、肾、肾上腺、心肌、胃肠道、淋巴组织及睾丸等也为靶器官。肺组织内以CD8+ 细胞浸润为主 ,杂以少数CD4 + 细胞 ;淋巴结及脾脏中CD3+ 、CD4 + 、CD8+ 和CD2 0 + 淋巴细胞亚群呈不同程度减少及比例失衡 ,而
Objective To study the pathological features of severe acute respiratory syndrome (SARS) and the pathological basis of clinical treatment and to explore the pathogenesis of SARS. Methods Two cases of SARS autopsy and four cases of multi-organ multi-site puncture were observed by light and electron microscopy. The distribution and number of lymphoid subpopulations in lung tissues and immune organs were analyzed by immunohistochemistry ; Nucleic acid in situ hybridization combined with electron microscopy, SARS coronavirus (SARS CoV) in etiology and quantitative detection. Results Six cases of SARS showed diffuse alveolar epithelial injury in lung tissue. Two of the autopsy lung tissues showed acute interstitial and regional pulmonary edema, two autopsy and one case of puncture lung tissue with alveolar clear membrane formation. One case Autopsy and 2 cases of puncture lung tissue desquamation of terminal bronchiolitis and alveolitis, 2 cases of puncture see early pulmonary fibrosis and alveolar mechanical. SARS extrapulmonary organs, 2 cases of disease <12dSARS immune organs showed a more extensive hemorrhagic necrosis inflammation, tissue cells and monocyte-like immunoblastic reactivity hyperplasia, bone marrow mononuclear cell system was relatively inhibited, and 4 cases Duration> 2 1dSRAS cases of splenic peripheral T lymphocytes around the central artery, bone marrow was roughly normal. In vivo, there are many target cells and target organs infected by SARS CoV, of which the lungs are the main target organs, and the bronchi, kidney, adrenal gland, myocardium, gastrointestinal tract, lymphoid tissues and testis are also target organs. In the lung tissue, the infiltration of CD8 + cells was predominant, with a few CD4 + cells. The lymphocyte subsets of CD3 +, CD4 +, CD8 + and CD20 + in lymph nodes and spleens were decreased and imbalanced