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目的 研究严重急性呼吸综合征(SARS)尸检组织的临床病理和超微结构特征。方法 对1例SARS死亡患者做即刻肺穿刺和12h后尸检,进行病理形态和超微结构的观察;用Macchiavello法做病毒包涵体染色;并对淋巴结、脾脏、结肠、小肠及骨髓组织行CD20、CD45RO(UCHL-1)、CD4、CD8、CD68、CD34免疫组织化学标记。结果 SARS肺的主要病变为急性弥漫性全小叶性间质性炎,可见肺泡腔内透明膜形成和增生及脱落的肺泡上皮,偶见胞质内病毒包涵体样结构,病毒包涵体染色阳性,肺内小血管增生、扩张,呈血管炎性改变。淋巴结、脾脏结构破坏,淋巴滤泡消失,脾小体萎缩,淋巴细胞明显减少,组织细胞增生;结肠小肠孤立和集合淋巴结淋巴滤泡消失;骨髓增生减低,巨核细胞增多。免疫组织化学染色:淋巴结、脾脏B细胞CD20弥漫散在阳性,CD45RO(UCHL-1)散在阳性,CD4辅助T细胞显著减少,CD8毒性T细胞稍增加,CD4/CD8比例明显小于0.5。电镜观察:肺泡内的单核巨噬细胞、肺泡上皮胞质内可见病毒样颗粒,大小80～160nm,有光晕或花环状包膜。结论 肺部明显急性弥漫性全小叶性间质性炎,肺泡腔透明膜形成,肺外淋巴造血系统明显损害,尤T细胞明显;内脏器官出血、坏死和血管炎改变等为急性SARS的形态特征;肺内所见病毒样颗粒可能为新型冠状病毒,推测其为此次SAR
Objective To study the clinicopathological and ultrastructural features of autopsy in patients with severe acute respiratory syndrome (SARS). Methods One patient with SARS died immediately after lung puncture and autopsy at 12h. The pathological changes and ultrastructure were observed. Macchiavello method was used to detect the inclusion bodies. The lymph nodes, spleen, colon, small intestine and bone marrow were examined for CD20, CD45RO (UCHL-1), CD4, CD8, CD68, CD34 immunohistochemical markers. Results The main pathological changes of lung in SARS were acute diffuse lobular interstitial inflammation. The formation of alveolar clear membrane and the proliferation and shedding of alveolar epithelium were observed. Occasional cytoplasmic viral inclusion bodies, Pulmonary small vessel hyperplasia, expansion, showed vascular inflammatory changes. Lymph node, spleen structure destruction, disappearance of lymphoid follicles, spleen body atrophy, significantly reduced lymphocytes, tissue cells hyperplasia; colonic small intestine isolated and lymph node follicles disappear; myeloid hyperplasia decreased, increased megakaryocytes. Immunohistochemical staining: CD20 diffuse positive in lymph nodes and spleen B cells, CD45RO (UCHL-1) scattered positive, CD4 helper T cells decreased significantly, CD8 toxic T cells slightly increased, CD4 / CD8 ratio was significantly less than 0.5. Electron microscopy: mononuclear macrophages in the alveoli, alveolar epithelial cytoplasm can be seen within the virus-like particles, the size of 80 ~ 160nm, a halo or garland envelope. Conclusions The acute diffuse common lobular interstitial pneumonia, the formation of the alveolar clear membrane and the extrapulmonary lymphatic hematopoietic system were significantly impaired in the lungs, especially in T cells; the changes of the internal organs such as hemorrhage, necrosis and vasculitis were the morphological features of acute SARS ; The virus-like particles seen in the lung may be a new type of coronavirus, which is presumed to be the SAR