干旱区生态环境知识资源中心(Arid): 严重急性呼吸综合征的病理改变

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	严重急性呼吸综合征的病理改变
其他题名	Morphological study of severe acute respiratory syndrome (SARS)
	陈杰 1; 张宏图 2; 谢永强 2; 万建伟 1; 卢朝辉 1; 王德田 1; 王青峙 3; 薛新华 2; 司文学 3; 罗玉凤 1; 邱红梅 1
来源期刊	中华病理学杂志
ISSN	0529-5807
出版年	2003
卷号	32 期号:6 页码:516-520
中文摘要	目的探讨严重急性呼吸综合吸综合征（SARS）的主要脏器的病理改变特点及发病机制。方法详细检查7例SARS患得的肺、心、脾、肝、肾等标本的大体特点及用常规方法研究光镜下SARS累及各脏器的病变特点。结果 7例中，病程短（5 d）的患者肺部表现以肺肿为主。与通常的肺水肿相比，其水肿液中纤维素成分多，可见透明膜形成。5例病程超过3周的患者出现肺泡内机化及肺泡间隔内的纤维母细胞增生，造成肺泡的实变和团塞。6例可见到肺小血管内的微血栓。7例均可见到散在的肺出血、小叶性肺炎、肺泡上皮脱落、增生等病变。2例可见真菌感染，1例累及左全肺及右织减少，窦组织细胞增多。5例心脏有明显的肥大，2例有心内血栓，1例有灶性心肌炎，1例为真菌性心肌炎。7例中有1例为结节性肝硬化，另1例出现广泛的肝细胞带状坏死。脾内均有白髓变小或消失，红髓明显充血和出血。1例腹腔内淋巴结肿大，但其内淋巴滤泡亦减少，有明显充血和出血及窦组织细胞增生。结论 SARS的主要病变为肺，以各期弥漫性肺泡损伤的病变为基本特征。发病机制可能为病毒造成泡上皮及毛细血管的严重损伤导致肺水肿及肺泡及细支气管的纤维素性渗出性炎，出现透明膜，继而出现肺泡内机化及肺泡间隔的纤维化，导致肺泡萎陷，最终形成纤维化、实变。脾和淋巴结的淋巴组织减少是此病影响免疫系统的形态学表现。
英文摘要	Objective Seven oases of autopsy from SARS patients are studied to investigate the pathogenesis and the pathologic changes of the major organs. Methods Detailed gross and microscopic examination of the autopsy specimen is performed, including lung, heart, liver, kidney, spleen and lymph nodes. Results All of the lungs are markedly enlarged and consolidated. Microscopically, pulmonary edema is a prominent finding, especially at the early stage of the disease (5 days after the onset). The alveolar spaces are filled with fibrinous exudates and lined with hyaline membrane. In 5 cases that undergo over 3 weeks of the course, the main pattern is organization of intra-alveolar deposit, along with fibroblastic proliferation in the alveolar septa, which leads to obliteration of alveolar space and pulmonary fibrosis. All of the lungs show bronchopneumonia, scattered hemorrhage, and proliferation of alveolar epithelial cells with desquamation. Microthrombi are seen in 6 cases. Fungal infection is noted in 2 cases. One of them is disseminative, involving bilateral lungs, heart, and kidney; the other one is diagnosed in hilar lymph nodes. In immune system, hilar and abdominal lymph nodes are usually congested and hemorrhagic, with depletion of lymphocytes, and accompanied with subcapsular sinus histiocytosis. One of the cases shows enlargement of abdominal lymph nodes, which have reduced number of germinal centers. Spleen exhibits atrophy of white pulps, and even lost of white pulps in some areas. The red pulp is markedly congested and hemorrhagic. In 5 cases, cardiomegale is prominent. Thrombosis (2 cases), focal myocarditis (1 case) , and fungal myocarditis (1 case) are observed. In addition, liver shows massive necrosis (1 case) and nodular cirrhosis (1 case). Conclusions Lung is the major organ affected by SARS, demonstrated as diffuse alveolar damage. It is postulated that viral infection induces severe damage of alveolar epithelial and capillary endothelial cells, leads to pulmonary edema, intra-alveolar fibrin deposit, and hyaline membrane formation. Consequently, intra-alveolar organization and alveolar septal fibrosis causes loss of alveolar spaces, eventually, pulmonary fibrosis and atelectasis. The immune system is often affected, and presented as depletion of lymphoid tissue in lymph nodes and spleen. Secondary infection is a common complication, which should be paid close attention in the management of SARS patients.
中文关键词	肺炎 ; 病毒性 ; 冠状病毒感染 ; 呼吸功能不全 ; 尸体解剖
英文关键词	pneumonia viral coronavirus infections respiratory insufficiency autopsy
语种	中文
国家	中国
收录类别	CSCD
WOS类目	MEDICINE GENERAL INTERNAL
WOS研究方向	General & Internal Medicine
CSCD记录号	CSCD:1216157
资源类型	期刊论文
条目标识符	http://119.78.100.177/qdio/handle/2XILL650/204713
作者单位	1.中国医学科学院中国协和医科大学北京协和医院病理科, 100730; 2.中国医学科学院肿瘤医院; 3.阜外心血管病医院病理科
推荐引用方式 GB/T 7714	陈杰,张宏图,谢永强,等. 严重急性呼吸综合征的病理改变[J],2003,32(6):516-520.
APA	陈杰.,张宏图.,谢永强.,万建伟.,卢朝辉.,...&邱红梅.(2003).严重急性呼吸综合征的病理改变.中华病理学杂志,32(6),516-520.
MLA	陈杰,et al."严重急性呼吸综合征的病理改变".中华病理学杂志 32.6(2003):516-520.