【作者】 赖日权； 冯晓冬； 王卓才； 赖晃文； 田野； 张伟； 杨传红；

【Author】 LAI Ri-quan, FENG Xiao-dong, WANG Zhuo-cai, LAI Huang-wen, TIAN Ye, ZHANG Wei, YANG Chuan-hong. General Hospital of Guangzhou Command, Guangzhou 510010, China

【机构】 广州军区总医院病理科；

【摘要】 目的研究严重急性呼吸综合征(SARS)尸检组织的临床病理和超微结构特征。方法对1例SARS死亡患者做即刻肺穿刺和12 h后尸检,进行病理形态和超微结构的观察;用Macchiavello法做病毒包涵体染色;并对淋巴结、脾脏、结肠、小肠及骨髓组织行CD20、CD45RO(UCHL-1)、CD4、CDS、CD68、CD34免疫组织化学标记。结果肺组织的主要病变为急性弥漫性全小叶性间质性炎,可见肺泡腔内透明膜形成和增生及脱落的肺泡上皮,偶见胞质内病毒包涵体样结构,病毒包涵体染色阳性,肺内小血管增生、扩张,呈血管炎性改变。淋巴结、脾脏结构破坏,淋巴滤泡消失,脾小体萎缩,淋巴细胞明显减少,组织细胞增生;结肠、小肠孤立和集合淋巴结淋巴滤泡消失;骨髓增生减低,巨核细胞增多。免疫组织化学染色:淋巴结、脾脏B细胞CD20弥漫散在阳性,CD45RO(UCHL-1)散在阳性,CD4辅助T细胞显著减少,CD8毒性T细胞稍增加,CD4/CD8比例明显小于0.5。电镜观察:肺泡内的单核巨噬细胞、肺泡上皮胞质内可见病毒样颗粒,大小80～160nm,有光晕或花环状包膜。结论肺部明显急性弥漫性全小叶性间质性炎,肺泡腔透明膜形成,肺外淋巴造血系统明显损害,尤T细胞明显;内脏器官出血、坏死和血管炎改变等为急性SARS的形态特征;肺内所见病毒样颗粒可能为新型冠状病毒.推测其为此次SARS流行的主要病原位。更多还原

【Abstract】 Objective To study the morphological, ultramicrostructural and pathological changes of tissues from a patient with severe acute respiratory syndrome ( SARS) . Methods One autopsy case of diagnosed SARS was investigated. Lung puncture was performed immediately after the patient died, and the autopsy was done 12 h later. The specimens from lymph nodes, spleen, small intestine , colon and bone marrow were studied by immunohistochemical technique. The antibodies used included CD20, CD45RO (UCHL-1) ,CD4, CDS, CD68 and CD34. Results The principal lesions of the SARS case consisted of acute lobular intrastitial pneumonia, the hyaloid membranes of pulmonic alveoli and hyperplasia and shedding of alveolar epithelium of. Virus-like inclusions occasionally contained cytoplasm of the alveolar epithelium, which were positive by histochemical staining. The adjacent blood-vessels were changed by hyperplasia and enlargement. The structures of lymph nodes and spleen were damaged with lymph follicles depletion and splenic nodules atrophy. The specific changes included reduction of lymphocytes and hyperplasia of histiocytes, depletion of the follicles of small intestine and colon wall, decreased hyperplasia of the bone marrow and increased numbers of the megakaryocyte. Meanwhile, in the immunohistochemical study, CD20 + B cells were fully expressed in lymph nodes and spleen, and the CD45RO+ (UCHL-1) + T cells were scatteredly expressed. The number of CD4 + help T cell was markedly decreased, while the number of CDS + poisonal T cells increased, and the ratio of the former and latter was no more than 0. 5. Under the electronic microscropy observation, virus-like particles with 80-160 nm diameter and halo or garland envelope were found in mononuclear macrophage and cytoplasm of alveolar epithelium. Conclusions The specific lesions of SARS consist of lobular intrastitial pneumonia with the formation of hyaline membranes of lung , haemorrhage, necrosis, inflammation of blood vessels and the damages of extralung lymphohemopioetic system. The damages were very similar to the pathological features of tissues infected by human immunodeficiency virus, in which numbers of T cells decreased and CD4 + T cell/CD8 * T cell ratio was no more than 0. 5. According to the virus-like particles found in lung of the SARS case, it is considered that these virus-like particles may be a new kind of coronavirus which caused the "atypical pneumonia".更多还原