61例儿童病毒性肺炎死亡案例回顾性分析

Retrospective Analysis of 61 Cases of Children Died of Viral Pneumonia

目的回顾性分析儿童病毒性肺炎死亡原因鉴定案例的法医病理学尸体检验及临床资料,探讨儿童病毒性肺炎的发病特点及病理学特征,为儿童因2019新型冠状病毒感染导致病毒性肺炎的病理诊断提供参考。方法收集南方医科大学司法鉴定中心近年来儿童死亡原因鉴定意见为病毒性肺炎死亡的尸体检验资料共61例,对性别、年龄、临床症状及病理学特征等进行比较分析。结果61例病毒性肺炎死亡儿童中,年龄主要集中在2岁以内(83.61%),发病后2周内死亡占比较大(91.80%)。尸体检验大体改变包括呼吸道黏膜充血、胸腔积液、肺膨隆、肺胸膜浆膜花斑样改变、肺局灶性出血及肺水肿,肠系膜淋巴结肿大占比较高(83.61%),有21.31%的患儿存在胸腺发育不良。组织病理学改变主要包括肺泡和间质水肿、肺出血、肺泡上皮细胞脱落、肺泡内浆液性和(或)纤维素性渗出、病毒包涵体形成、透明膜形成,间质及肺泡内以巨噬细胞和淋巴细胞为主的炎症细胞浸润。病毒感染常累及心脏和胃肠道。结论儿童病毒性肺炎临床表现隐匿,因儿童免疫系统发育不健全、自身免疫力差,极易转化成重症甚至死亡。通过分析法医学尸体解剖及组织病理学特点,可为病毒性肺炎的病理诊断提供参考。

Objective To retrospectively analyze the forensic pathological postmortem examination and clinical data of children who died of viral pneumonia in identification of cause of death cases and to discuss the clinical characteristics and pathological features of viral pneumonia in children,in order to provide reference to pathological diagnosis of viral pneumonia in children caused by 2019 novel coronavirus(2019-nCoV)infection.Methods Postmortem examination data from 61 cases of children whose causes of death were identified as viral pneumonia in recent years were collected from the Center of Forensic Identification,Southern Medical University.The gender,age,clinical symptoms and pathological features were comparatively analyzed.Results Among the 61 cases of children who died of viral pneumonia,most were within 2 years old(83.61%),and a large proportion died within 2 weeks after the onset of the disease(91.80%).Gross changes in postmortem examination included respiratory mucosal hyperemia,pleural effusion,pulmonary swelling,variegated pulmonary pleura and serosa,as well as focal pulmonary hemorrhage and pulmonary edema.A large proportion of sick children had enlarged mesenteric lymph nodes(83.61%)and thymic dysplasia(21.31%).Histopathological changes included edema of alveoli and interstitial substance,pneumorrhagia,shedding of alveolar epithelial cells,serous and(or)fibrous exudation in the alveoli,formation of viral inclusions,formation of transparent membranes,infiltration of inflammatory cells that mainly consisted of macrophages and lymphocytes in interstitial substance and alveoli.Viral infections often affected the heart and gastrointestinal tract.Con⁃clusion The clinical symptoms of children with viral pneumonia are difficult to notice,and because the immune systems of children are not fully developed and they have poor immunity,they can easily become severely ill and even die.Analyzing the forensic autopsies and the histopathological characteristics could provide reference for pathological diagnosis of viral pneumonia.