严重急性呼吸综合征肺纤维化的病理过程初步研究

Pathologic process of pulmonary fibrosis in severe acute respiratory syndrome:a preliminary report

目的：探讨不同时间SAILS死亡患者肺纤维化的病变经历过程及特点。方法：以6例SAILS死亡患者（分别于发病后9，14，20，29，33。38d死亡）肺标本为对象，应用常规HE染色、三联染色、苦味酸-天狼猩红-偏振光法和电镜等技术方法，观察SARS肺组织的病理变化和纤维化的病理过程以及胶原纤维、网状纤维和弹力纤维的变化特点、Ⅰ型与Ⅲ型胶原纤维分布规律及其超微结构变化。结果：SARS发病后于9—38d死亡的6例患者肺脏出现程度不等的成纤维细胞变化和纤维组织增生，其中2例（33，38d）发生典型的肺纤维化病变。肺间质组织和成纤维细胞变化可大致分为4种类型：成纤维细胞轻度活跃型，见于9，14d死亡例；成纤维细胞增生型，见于20d死亡例；纤维组织增生型，见于29d死亡例；纤维化形成型，见于33，38d死亡例。经三联染色和天狼猩红染色证实，纤维增生以胶原为主，其中Ⅰ型胶原增生较Ⅲ型胶原明显。结论：初步认为，肺脏4种类型病变本质上反映了SARS肺纤维化的发生发展过程，可能经历4个阶段，即：成纤维细胞轻度活跃期、成纤维细胞增生期、纤维组织增生期和纤维化形成期。SARS肺纤维化病变特点为：（1）纤维化出现较早（33d）；（2）纤维化病变呈进行性发展；（3）以Ⅰ型胶原纤维为主：（4）局灶性分布突出。

Objective： To explore the pathologic process and characteristics of pulmonary fibrosis of severe acute respiratory syndrome（SARS） patients who died in different periods of time. Methods： The lung preparations of 6 SARS death patients （ died on days 9, 14, 20, 29, 33 and 38） were used as the study objects. Pathological changes, collagen fibers, lattice fibers, elastic fibers, collagen types Ⅰ and Ⅲ in lungs and fine structure changes were studied by routine HE staining, trigeminy staining, trinitropbenol-sirius red staining and polarization microscopy and electron microscopy. Results： The lungs of 6 SARS death patients （ died on days 9 - 38 ） had different degrees of fibroblast changes and fibroplasia, which developed to typical pulmonary fibrosis on days d 33 and 38 in 2 cases. Basic processes of SARS pulmonary fibrosis could be classified into 4 types： fibroblast low-degree active stage （on days 9 -14）, fibroblast proliferation stage （on d 20）, fibrous tissue proliferation stage （on d 29）, and fibrosis emerge stage （on days 33 -38）. Collagen fibers were the major component in fibrous proliferation. Collagen type- Ⅰ was more obvious than collagen type-Ⅲ. Condusion ：The basic processes of SARS pulmonary fibrosis go through possibly four stages： fibroblast low-degree active stage, fibroblast proliferation stage, cfibrous tissue prohferation, stage, and fibrosis emerge stage. The features of SARS pulmonary fibrosis are as follows： （ 1 ） Fibrosis appeared early （ on d 33）. （2） Fibrosis changes develope progressively. （ 3 ） Collagen type- Ⅰ is more obvious than collagen type-Ⅲ. （4）Focal distribution is outstanding.