SARS超微病理学观察

An Observation of Uitralstructural Pathology of SARS Patients

目的探讨SARS超微病理学及病原学特点.方法应用透射电镜、光镜、组织化学和免疫学方法对2例1～2周病程的早期SARS死亡尸检病例和4例3～5周病程的中晚期SARS死亡病例进行观察研究.结果两组SARS病例肺泡Ⅱ型上皮细胞、血管内皮细胞,心肌细胞、肝窦内皮细胞、肾小管上皮细胞胞质和血液内冠状病毒样颗粒具有多态性,大小为60～220 nm,以具有低电子密度核心的A型病毒颗粒和高电子密度核心的C型病毒颗粒较为多见,偏心性高电子密度核心的B型病毒颗粒也可见到;还可以见到无明显包膜的病毒体样颗粒以及不规则形状的病毒颗粒.病程1～2周死亡病例主要为肺泡上皮细胞损伤性和增生性改变,板层小体减少,表面活性物质膜消失.病程3～5死亡病例以肺泡间质纤维增生和肺泡早期纤维化等为主要表现.肺泡隔间质中纤维母细胞增生明显,小血管壁增厚.Ⅱ型肺泡上皮细胞增生.结论SARS不同病程死亡病人的肺部超微结构改变有不同的特征.多个脏器内均见到冠状病毒样颗粒,主要损害肺脏和免疫器官.认识和研究SARS不同病程的超微病理学和病原学特点,将为SARS临床诊断和治疗提供重要的理论依据和病理学基础.

Objective To study ultrastructural pathological characteristics and etiology of Severe Acute Respiratory Syndrome （SARS）. Methods Post-mortem tissue samples of multi- needle biopsy from four SARS patients who died at 3～5 weeks of middle and late stages. Systematic autopsies were carried on two SARS cases who died at 1 ～ 2 weeks of early stage organs. The pathological samples were studied by electron microscope, lmmunohistochemistry, histochemistry and indirect immunofluorcscent antibody test. Results Eleetron microscopy showed the coronavirus-like particles（Type A, Type B and Type C） with the diameter of 60～220 nm and the ervelopcs located and in the lungs and extra-lung： organs. Polyinorphism of the eoronsvirus-like particles was revealed. The main pathological features of 1～ 2 weeks of early stages of SARS showed the damage and proliferation of alveolar pneumocytcs. The main pathological features of 3～5 weeks of middle and Late stages of SARS were tho early interstitial pulmonary fibrosis. Fibroblasts incressed in the interalveoli septa and pneumocyte hyperplasia was also seen. Conclusion A novel coronavirus is the cause of the newly recognized severe acute respiratory syndrome（SARS）. The lungs revealed the different pulmonary pathological features. To study the features of ultrastructural pathology will offer the important theoretical basis for clinical diagnosis and treatment.