SARS尸检的肺部病理改变

Lung Pathology of Severe Acute Respiratory Syndrome

目的通过研究严重急性呼吸综合征(severeacuterespiratorysyndrome,SARS)患者的尸检肺部标本,总结SARS的肺部病变特点及发病机制。方法详细检查SARS患者肺脏标本的大体特点,并用常规方法研究显微光镜下SARS累及各肺叶的病变特点。结果7例SARS患者的双肺均明显膨胀,镜下表现以弥漫性肺泡损伤(DAD)不同时期的病变为主。7例均有肺水肿及透明膜形成,肺水肿尤以早期明显。病程超过3周者开始有肺泡内机化及肺间质纤维化,造成肺泡的纤维性闭塞。几乎每例都可见到小血管内的微血栓和肺出血、散在的小叶性肺炎、肺泡上皮脱落、增生等病变。2例可见曲霉菌感染,1例累及左全肺及右肺部分区域,1例出现在肺门淋巴结。肺门淋巴结多表现为充血、出血及淋巴组织减少,窦组织细胞增多。结论SARS肺可能为SARS病毒造成的弥漫性肺泡损伤,表现为肺泡上皮及毛细血管的严重损伤导致肺水肿和肺泡及细支气管的纤维素性渗出性炎症,出现透明膜,继而出现肺泡内机化及肺泡间隔的成纤维细胞增生,共同使肺泡萎陷、机化,最终形成纤维化实变。肺门淋巴组织的减少可能是此病影响免疫系统的又一形态学表现。

Objective To study the morphological features of the lungs obtained from autopsies of severe acute respiratory syndrome (SARS)patients.Methods Bilateral lungs from7patients died from SARS were carefully studied grossly and microscopically.All tissues from these cases were routinely processed and carefully studied.Results All lungs from these cases were extremely expanded and became solid.Microscopically,the edema and fibrin exudates in the alveoli was the most common findings,especially in the early phase of the disease.The hyaline membrane was almost always present in the lungs of these cases.The organization of intra-alveolar fibrin exudates along with the interstitial fibrosis led to obliteration of alveoli and consolidation of lungs.The desquamation and hyperplasia of alveolar lining cells was also apparent.Foci of haemorrhage and lobular pneumonia,even diffuse fungal infection were frequently seen in these specimens.Micro-thrombus were easily found in these lungs.Conclusions The lung of SARS from autopsy is characterized by edema,intra-alveolar fibrin exudates,hyaline membrane formation,organization of intra-alveolar exudates and fibrosis,which lead to the obliteration of alveoli and consolidation of lungs.