危重型手足口病3例尸检临床病理分析

Severe hand-foot-mouth disease:a report of 3 autopsied cases

目的探讨危重型手足口病死亡患者各脏器的病理改变特点,并分析其死亡原因。方法对3例危重型手足口病死亡病例作尸体解剖,镜检各脏器的病理改变,并分析主要脏器的病理改变与临床症状和体征的关系,探讨导致患者死亡的病变基础。结果危重型手足口病起病急,进展快,病程短,临床表现为发热、手足口疱疹、神经系统症状和突发性呼吸窘迫。病变累及的关键脏器是延髓、脑干和肺脏。延髓和脑干的病理改变是神经元变性坏死、脑软化灶形成、出现血管周围炎细胞浸润和噬神经细胞现象,呈病毒性脑炎改变。肺的病理改变是肺泡间隔毛细血管扩张充血,并大量单核细胞浸润;肺泡腔内大量单核细胞渗出,填满肺泡腔,致局部肺实变;局部肺透明膜形成;局部肺组织出血性梗死;局部肺泡腔内有大量水肿液;呈严重病毒性肺炎和急性肺水肿改变。此外,淋巴结和脾脏的结构破坏,淋巴小结萎缩,淋巴滤泡的生发中心细胞核碎裂,呈生发中心烧毁现象。结论危重型手足口病病毒侵犯患者肺、延髓、脑干和免疫器官,导致病毒性肺炎、病毒性脑炎和免疫器官损害。其中,延髓和脑干呼吸中枢的损害与肺部本身的严重病变协同作用引起的呼吸衰竭,是病人死亡的主要原因。

Purpose To investigate the clinicopathological features of severe hand-foot-mouth disease by autopsy,and to analyze the cause of the patient＇s dead.Methods Autopsies were performed on three cases of severe hand-foot-mouth disease,the pathological changes were studied by light microscopy,the correlation between the pathological changes and the clinical signs and symptoms was analyzed,and the reasons resulting in the death of patients were discussed.Results Severe hand-foot-mouth disease occurred suddenly and progressed rapidly with a short duration.The patients presented with hand,foot and mouth vesicular eruptions and sudden onset of respiratory failure accompanied by nervous system manifestations.The mainly involved organs were the medulla oblongata,brain stem and the lung.The brain stem and the medulla oblongata exhibited the degeneration and necrosis of the neurons,encephalomalacia,lymphocytic infiltration around the vessels,neuronophagia and the formation of glial cell nodules,which was consistent with the viral encephalitis.The lung showed the widening of alveolar septa,the congestion of capillaries and the infiltration of a large number of macrophages,which also effused into the alveolar space,resulting in focal lung consolidation.The exudate in the alveolar space and the hyaline membrane were focally present.Focal pulmonary infarction was observed due to the pulmonary embolism.The changes in the lung were consistent with the interstitial pneumonia and acute pulmonary edema.Additionally,the lymph nodes and the spleen showed structural destruction by showing the follicular atrophy and the karyorrhexis of the cells in the follicular center,or a burning-out feature.Conclusions In the severe hand-foot-mouth disease,the virus not only involves the skin and oral mucosa,but also the medulla oblongata,brain stem and the lung,resulting in the viral encephalitis,viral pneumonia and neurogenic pulmonary edema,and consequently leading to the respiratory failure,which is responsible for the patient＇s death.