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20 0 2年 11月在广东发现首例严重急性呼吸综合征 (俗称“非典型性肺炎”)病例。 2 0 0 3年 2月世界卫生组织 (WHO)在越南河内正式确认此疾病为新的人类传染病 ,并命名为严重急性呼吸综合征 (severeacuterespiratorysyndrome ,SARS)。 2 0 0 3年 3月在香港发现其病原体为新的冠状病毒 (coronavirus) ,称之为SARS冠状病毒 (SARS CoV)。SARS患者常常出现异常的血液学改变 ,包括淋巴细胞减少 (在成人为 6 8% - 90 % ;在儿童为 10 0 % ,n =10 ) ,血小板减少 (成人 2 0 % - 4 5 % ,儿童 5 0 % ) ,和白细胞减少 (成人 2 0 % - 34% ,儿童 70 % )。同时在部份患者D 二聚体水平可见升高。初步的研究表明SARS冠状病毒可侵犯造血细胞 ,但作用机制尚不清楚。我们推测其病理生理过程可能包括 :(1)通过CD13或CD6 6a受体 ,SARS病毒直接侵入造血细胞或感染骨髓基质细胞等 ,加重细胞凋亡 ,引致造血抑制 ;(2 )通过生成自身抗体或免疫复合物等免疫介导造成细胞损害。肺部损害也可部分解释血小板减少。肺部可能是成熟巨核细胞释出血小板的器官之一。SARS病人有广泛肺泡损害 ,包括充血、水肿、透明膜形成和肺纤维化 ,使肺部有效毛细血管床减少 ,从而血小板生成减少。同时 ,炎症损伤使肺部血小板聚集、血栓形成 ,也引致血小板?
The first case of SARS (commonly known as “SARS”) was found in Guangdong in November 2002. February 2003 The World Health Organization (WHO) formally confirmed the disease as a new human disease in Hanoi, Vietnam, and named it SARS (Severe Acute Respiratory Syndrome Syndrome). In March 2003, the pathogen was discovered in Hong Kong as a new coronavirus called SARS CoV (SARS CoV). Patients with SARS often have abnormal hematologic changes, including lymphopenia (68% -90% in adults; 10% in children, n = 10), thrombocytopenia (20% -45% in adults, 50%), and leukopenia (20% - 34% in adults and 70% in children). At the same time in some patients can be seen D dimer level increased. Preliminary studies have shown that SARS coronavirus can invade hematopoietic cells, but the mechanism of action is not clear. We speculate that the pathophysiological process may include: (1) SARS virus directly invades hematopoietic cells or infects bone marrow stromal cells through CD13 or CD6 6a receptors, which aggravates apoptosis and leads to hematopoietic suppression; (2) through the production of autoantibodies or Immune complexes such as immune-mediated cell damage. Pulmonary damage may also partially explain thrombocytopenia. The lungs may be one of the organs that mature megakaryocytes release platelets. SARS patients have extensive alveolar damage, including congestion, edema, hyaline membrane formation and pulmonary fibrosis, the effective reduction of pulmonary capillary bed, resulting in reduced platelet production. At the same time, inflammation of the lungs so that platelet aggregation, thrombosis, but also lead to platelets?