急性重症感染合并出血坏死性肾上腺炎死亡十例分析

Analysis of 10 cases died from the acute infectious disease with the severe adrenalitis, necrosis and hemorrhage

目的探讨出血坏死性肾上腺炎在急性重症感染性疾病死亡中的作用。方法回顾性分析1998至2007年系统法医病理学解剖案例中10例原发性重症感染性疾病合并严重出血坏死性肾上腺炎案例的临床病理资料。结果10例中临床诊断上呼吸道感染6例，感染性休克2例，急性食管炎1例，诊断不明1例。均病情迅速恶化而死亡。尸检7例为急性淋巴细胞性全心炎，2例为急性淋巴细胞性间质性肺炎，1例为暴发性脑膜炎球菌败血症，均合并严重的出血坏死性肾上腺炎、全身炎症反应综合征和多器官衰竭。结论肾上腺炎性出血坏死应属于常见的致死性多器官功能衰竭的重要器官病变之一，临床应予重视。

Objective To discuss the potential mechanisms and the role of adrenalitis with extensive hemorrhage and necrosis in acute critical infectious diseases. Methods Forensic autopsy cases from 1998 to 2007 were retrospectively analyzed. And 10 cases of them were involved in the primary and critical infection with acute inflammation, hemorrhage and necrosis of adrenal glands. Results Clinical diagnoses of 10 cases were respiratory tract infection （n = 6）, septic shock （n = 2）, acute esophagitis （n = 1 ）, and undefined causes （ n = 1 ）, and the quickly aggravatinng conditions resulted in death ultimately. However, systematic autopsy confirmed that 7 cases died of acute lymphocytic pancarditis, 2 cases acute and lymphocytic interstitial pneumonia and 1 case epidemic cerebrospinal meningitis with septicemia. And severe complications of all cases included hemorrhagic necrotizing adrenalitis, systemic inflammatory response syndrome and multiple organ failure （MOF）. Conclusions Hemorrhagic necrotizing adrenalitis should be considered as one of the important pathological changes in fatal MOF resulting from severe infection and trauma etc. More attention should be paid in clinical treatment.