从SARS患者肺部病变的病理特点探讨SARS的损伤机理

Mechanisms of lung injury in severe acute respiratory syndrome (SARS): histopathological analysis

目的 根据严重急性呼吸道综合征 (severeacuterespiratorysyndrome ,SARS)患者肺部病变的病理特点探讨SARS的损伤机理。方法 在 35 0 0例尸体解剖材料中 ,找出死亡时有肺部炎症的共 84 2例。对其中病毒性肺炎 16例、Good Pasture综合征 2例、自身免疫疾病 2例、SARS 1例 ,共 2 1例进行肺部病变的病理组织学的比较观察。结果 病毒性肺炎的肺部病变主要的病理变化表现为间质性肺炎 ;自身免疫性疾病病人的肺部病理变化有肺泡表面透明膜形成 ,肺泡腔内脱落的细胞团 ,肺泡腔内机化等 ;SARS病人尸体解剖的肺部病变主要为肺泡腔内细颗粒样或泡状肺水肿 ,脱屑性肺炎以及机化性肺炎的表现。同时 ,肺间质内的小动脉出现明显的结构改变 ,形态学上与自身免疫性疾病的肺损伤相似。结论 机体的变态反应可能是SARS的损伤机理之一。

Objective To evaluate the pathogenesis of severe acute respiratory syndrome (SARS) from the pathological changes of lung. Methods In the archived 3?500 cases of autopsy, pulmonary inflammation could be found in 842 cases. Among them, 16 cases of viral pneumonia, 2 cases of Good Pasture syndrome, 2 cases of autoimmune disease and 1 case SARS were observed comparatively with the method of histopathology. Results In the common viral pneumonia, the pathological changes in the lung were that of interstitial pneumonia. The histopathological changes in the lung of autoimmune disease were characterized with hyaline membranes on the surface of alveolus, desquamated cellular corps and organizing changes in the alveolar spaces. The pulmonary changes of SARS were similar to that of autoimmune disease with the characters of granular or vacuolated pulmonary edema, desquamated and organizing pneumonitis, structure deterioration of pulmonary arterioles. Conclusion Immune mediated tissue damaging reaction may play an important role in the progress of SARS. [