【摘要】 20 0 2年 11月在广东发现首例严重急性呼吸综合征 (俗称“非典型性肺炎”)病例。 2 0 0 3年 2月世界卫生组织 (WHO)在越南河内正式确认此疾病为新的人类传染病 ,并命名为严重急性呼吸综合征 (severeacuterespiratorysyndrome ,SARS)。 2 0 0 3年 3月在香港发现其病原体为新的冠状病毒 (coronavirus) ,称之为SARS冠状病毒 (SARS CoV)。SARS患者常常出现异常的血液学改变 ,包括淋巴细胞减少 (在成人为 6 8% - 90 % ;在儿童为 10 0 % ,n =10 ) ,血小板减少 (成人 2 0 % - 4 5 % ,儿童 5 0 % ) ,和白细胞减少 (成人 2 0 % - 34% ,儿童 70 % )。同时在部份患者D 二聚体水平可见升高。初步的研究表明SARS冠状病毒可侵犯造血细胞 ,但作用机制尚不清楚。我们推测其病理生理过程可能包括 :(1)通过CD13或CD6 6a受体 ,SARS病毒直接侵入造血细胞或感染骨髓基质细胞等 ,加重细胞凋亡 ,引致造血抑制 ;(2 )通过生成自身抗体或免疫复合物等免疫介导造成细胞损害。肺部损害也可部分解释血小板减少。肺部可能是成熟巨核细胞释出血小板的器官之一。SARS病人有广泛肺泡损害 ,包括充血、水肿、透明膜形成和肺纤维化 ,使肺部有效毛细血管床减少 ,从而血小板生成减少。同时 ,炎症损伤使肺部血小板聚集、血栓形成 ,也引致血小板?更多还原

【Abstract】 Severe acute respiratory syndrome (SARS) has recently recognized as a new human infectious disease. A novel coronavirus was identified as the causative agent of SARS. This report summarizes the hematological findings in SARS patients and proposes a hypothesis for the pathophysiology of SARS coronavirus related abnormal hematopoiesis. Hematological changes in patients with SARS were common and included lymphopenia (68%-90% of adults; 100% of children, n=10), thrombocytopenia (20%-45% of adults, 50% of children), and leukopenia (20%-34% of adults, 70% of children). The possible mechanisms of this coronavirus on blood system may include (1) directly infect blood cells and bone marrow stromal cells via CD13 or CD66a; and/or (2) induce auto antibodies and immune complexes to damage these cells. In addition, lung damage in SARS patients may also play a role on inducing thrombocytopenia by (1) increasing the consumption of platelets/megakaryocytes; and/or (2) reducing the production of platelets in the lungs. Since the most common hematological changes in SARS patients were lymphopenia and immunodeficiency. We postulate that hematopoietic growth factors such as G CSF, by mobilizing endogenous blood stem cells and endogenous cytokines, could become a hematological treatment for SARS patients, which may enhance the immune system against these virus.更多还原