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目的 探讨严重急性呼吸综合征 (SARS)病理学改变和超微结构特点及其与临床病程的关系。方法 应用光镜、组织化学、透射电镜、免疫组化和间接免疫荧光法对病程为 3～ 5周的 4例中晚期SARS死亡病例多器官穿刺组织 (肺脏、心脏、肝脏、脾脏、肾脏、胰腺、胃)进行研究。结果 SARS死亡病例肺部病理改变以肺泡间质纤维增生和肺泡早期纤维化等机化性肺炎表现为主要特征 ,同时有弥漫性肺泡损伤和脱屑性肺炎改变。脾脏内CD3和CD2 0阳性淋巴细胞减少 ,CD6 8阳性的组织细胞和S 10 0阳性的树突状细胞增多。骨髓粒细胞系统增生减退。在肺泡Ⅱ型上皮细胞、血管内皮细胞和脾脏淋巴细胞胞质内可见多种类型的冠状病毒样颗粒 ,大小均为 6 0～2 2 0nm ,有包膜 ,表面似有纤突样结构 ,以具有同心圆外膜、低电子密度核心的A型病毒颗粒和具有高电子密度核心的C型病毒颗粒为多见。间接免疫荧光法血清检测 4例病人SARS病毒IgGAb均呈明确阳性反应。结论 SARS是由新型冠状病毒引起的急性呼吸道传染病 ,主要靶器官是肺脏和免疫器官。SARS不同病程死亡病人的肺部病理学改变有不同的特征。
Objective To investigate the pathological changes and ultrastructural features of severe acute respiratory syndrome (SARS) and its relationship with clinical course. Methods Four cases of advanced SARS death cases with multiple organ puncture (lung, heart, liver, spleen, kidney and pancreas) were treated with light microscopy, histochemistry, transmission electron microscopy, immunohistochemistry and indirect immunofluorescence. , Stomach) to study. Results The pathological changes of lung in the death cases of SARS were mainly characterized by the pathogenesis of opportunistic pneumonia such as alveolar interstitial fibrosis and early alveolar fibrosis, with diffuse alveolar damage and desquamation pneumonia. CD3 and CD20 positive lymphocytes in the spleen were decreased, CD6 8-positive tissue cells and S 10 0-positive dendritic cells were increased. Bone marrow cell system hyperplasia. In the type Ⅱ alveolar epithelial cells, vascular endothelial cells and spleen lymphocyte cytoplasm can be seen in many types of coronavirus-like particles, the size of 60 ~ 220nm, with the envelope, the surface seems to have fiber-like structure to A-virus particles with concentric outer membranes, a low electron density core, and C-virus particles with a high electron density core are more common. Indirect immunofluorescence serum detection of 4 patients with SARS virus IgGAb showed a clear positive reaction. Conclusion SARS is an acute respiratory disease caused by new coronavirus. The main target organs are lung and immune organs. SARS pathological changes in patients with different pathological death have different characteristics.