摘要
目的 系统观察 6例严重急性呼吸综合征(SARS)不同时间死亡患者近 30个脏器的病理变化 ,探讨其病理发生发展过程及病变和病原体特点。方法 采用光镜、透射电镜、组织化学和部分免疫组织化学方法观察各脏器的病理变化。结果 ①重症SARS死亡患者早期基本病变为以肺和免疫器官 (脾、淋巴结、黏膜淋巴组织)为主的全身各脏器发生不同程度的实质细胞变性、凋亡和坏死等变质性改变和肺水肿、透明膜形成及出血等为主的血循环障碍 ;中后期则以肺上皮坏死脱落和间质纤维增生伴早期纤维化及免疫器官进行性萎缩等病变为主 ,再次证实肺和免疫器官为主要靶器官 ;②肺脏病变经历急性渗漏性炎症期 (发病后 2周内 ,主要病变为严重的弥漫性肺水肿和透明膜形成)、肺泡上皮坏死脱落伴增生机化性炎症期 (发病后 3～ 4周 )和纤维增生伴早期纤维化期 (发病后 5～ 6周 ) ,具有广泛性、速发性、进行性和阶段性、多样性等特点 ;③在重症SARS死亡患者中 ,脾和淋巴结等免疫器官发生严重的破坏和广泛出血 ,脾小体和淋巴滤泡极度萎缩 ,淋巴细胞迅速发生凋亡和坏死 ,T、B淋巴细胞数量极度减少 ,免疫功能极度低下 ,其病变同样具有广泛性、速发性和持续性等特点 ;④证实主要病原体为新型冠状病毒 ,衣原体样颗粒也是致病病原体之一 。
Objective To study the pathological characteristics, pathogenesis and the pathogen of severe acute respiratory syndrome (SARS) by systematic examination of the pathological changes in 30 organs from 6 autopsies of patients dying in different periods of the disease. Methods Pathological changes were studied by light microscopy, electron microscopy, histochemical and immunohistochemical staining. Results ①The basic pathological changes in the patients dying at the early stage of SARS were mainly degenerative changes, such as cellular degeneration, apoptosis and necrosis in the lung and immune organs (spleen, lymph nodes, and mucous membrane lymph tissue), and circulatory disturbances such as pulmonary edema, hyaloid membrane formataion and hemorrhage. In the patients dying at the middle and later stages, the basic pathological changes were necrosis and excoriation of pulmonary alveolar epithelial cells, interstitial fibrotic proliferation, accompanied by early fibrosis and progressive atrophy of lymphoid tissues. These results confirmed again that the lung and immune organs were the major target organs. ②The process of pulmonary changes could be divided into three periods: the first period was characterized by acute exudative and leakage inflammation (within two weeks of onset of the disease, the main pathological changes were severe diffuse edema and hyaline membrane formation in lung), the second period showed the feature of pulmonary epithelial necrosis and excoriation, accompanied by hyperplastic and organizational inflammation (within third to fourth weeks); the third period was hyperplasia and early fibrosis of pulmonary tissue (within fifth to sixth weeks) . The lung damages were widespread, immediate, progressive, staged and diverse. ③Serious damage and diffuse hemorrhage were observed in the immune organ, such as spleen, lymph nodes. Remarkable atrophy was seen in spleen nodules and lymph folliculi, with early apoptosis and necrosis of lymphocytes. The number of T cells and B cells were extremely decreased; the immune function became very low. The damages to the immune organs were widespread, immediate, and persistent. ④It was confirmed that novel coronavirus(Co v) was the major pathogen, and the chlamydia like particles was also one of the pathogens. At the same time, unknown stick like structures were found in the lung and spleen, and cocci were also found in the lung. Conclusions Examinations of the autopsy specimens from SARS patients showed that the pathogens were diverse, in which Co v was the major pathogen. The pathology involved multiple organs and cells in the human body, producing viremia. The lung and lymphoid tissues were the main target organs; pathological changes of the lung were progressive and could be divided into 3 stages. Pulmonary fibrosis occurred in 4～6 weeks. The atrophy of the immune organs was persistent and progressive. The immune function was low for a long time(The pictures were put into the color pages of this journal.).
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2003年第8期692-696,I002,I003,I004,I005,共9页
Medical Journal of Chinese People's Liberation Army
基金
国家自然科学基金专项资助课题(编号 30 340 0 2 3)
总后卫生部SARS防治研究指令性课题 (批准号 0 3F0 1 6 - 1 )
