严重急性呼吸综合征肺外器官的病理学观察研究

STUDIES OF PATHOLOGICAL CHANGES OF EXTRA-LUNG ORGANS IN A CASE OF SEVERE ACUTE RESPIRATORY SYNDROME

目的 进一步研究严重急性呼吸综合征 (SARS)的部分肺外器官的病理改变。方法 采用光镜、透射电镜及特殊染色方法 ,对 1例SARS的部分肺外器官行病理学观察。结果 患者除发生肺部变化之外 ,进一步观察发现 ,中枢神经系统 (包括大脑、小脑、丘脑、桥脑及延髓 )呈现脑膜血管扩张、充血 ,脑实质内血管周围间隙增宽 ,血管周围少量淋巴细胞及巨噬细胞浸润 ,但神经细胞无明显变性、坏死 ;消化系统表现为消化道粘膜固有层及粘膜下血管扩张、充血 ,少数淋巴细胞浸润 ,少部分粘膜上皮及腺上皮细胞核呈空泡状 ,偶见细胞凋亡 ,胰腺间质水肿 ,少数淋巴细胞浸润 ;睾丸曲细精管内偶见淋巴细胞浸润。本例死亡病例有冠状动脉粥样硬化疾病史。电镜下血管腔内血液中查见SARS冠状病毒颗粒 ,但脑、睾丸等组织内均未发现SARS冠状病毒颗粒。结论 SARS病例中枢神经系统可呈轻度缺氧反应性改变 ,未见冠状病毒感染 ;SARS发病期血液内存在冠状病毒 ;该死亡病例存在冠状动脉硬化基础病变 ,推测慢性心血管疾病等可能为SARS患者的死亡促发因素之一。

Objective To study the pathological changes in organs remote from the lung in SARS patient. Methods The pathological changes in extra lung organs and potential coronavirus infection were studied by using light and electron microscopic examinations as well as special virus inclusion stains in the tissues obtained from an autopsy of a patient who died of SARS. Results Besides the lesions in the lung, pathological changes were found also in the central nervous system (CNS), including the cerebrum, cerebellum, thalamus, pons, and medulla oblongata, such as widening of the Virchow Robin′s space, infiltration of a few lymphocytes and macrophages in the parenchyma, vasodilatation and congestion. However, no significant neuron degeneration or necrosis was identified. Vasodilatation in the lamina propria of mucosa and submucosa of the digestive tract with some lymphocytes infiltration, and epithelial nuclear vacuolation, and occasional apoptosis were observed in the mucosal epithelial and glandular cells, as well as focal hemorrhage in segments of the small intestine. Mesenchymal edema and infiltration of a few lymphocytes in the pancreas were noted. Very mild lymphocyte infiltration, but no viral inclusions, was found in the convoluted seminiferous tubules of the testis. The patient who died of SARS was proved to have arteriosclerosis of the coronary arteries, and coronavirul particles were identified in the blood vessels under electron microscopic examination, however no coronavirul particles were found in the brain or the testis of the patient. Conclusion There were mild hypoxic changes in the tissue of CNS in the patient with severe SARS without invasion of the virus. It was confirmed that there were coronavirul particles in the blood of the patient at the acute stage of SARS. Since the patient who succumbed to the disease had a history of coronary arteriosclerosis, it was inferred that cardiovascular disease might be a contributory factor of mortality in this patient with severe SARS.