The clinical pathology of severe acute respiratory syndrome (SARS): a report from China
The clinical pathology of severe acute respiratory syndrome (SARS): a report from China
复制标题
DOI：
10.1002/path.1440
复制
发表时间：
2003-07-01
影响因子：
7.3
通讯作者：
Yao, KT
中科院分区：
文献类型：
--
作者：
Ding, YQ;Wang, HJ;Yao, KT
为探讨严重急性呼吸综合征(SARS)的临床病理特点，对广东省南方医院3例SARS死亡患者中国的尸检资料进行了回顾性分析。用常规苏木精-伊红(H&E)染色对3例患者的所有组织进行研究。对肺组织标本进行Macchiavello染色、病毒包涵体染色、网织蛋白染色、PAS染色、免疫组织化学、超薄切片染色、光镜和透射电子显微镜观察。首发症状均为高热，其次为进行性呼吸困难和肺野阴影。双侧肺广泛实变，局限性出血、坏死，脱屑性肺泡炎、支气管炎，肺泡上皮细胞增生、脱屑，肺泡内蛋白、单核细胞、淋巴细胞、浆细胞渗出，肺泡上皮细胞内透明膜形成，病毒包涵体。脾淋巴组织大量坏死，淋巴结局限性坏死。全身性血管炎包括心、肺、肝、肾、肾上腺和横纹肌间质的水肿、局限性纤维素样坏死、单核细胞、淋巴细胞和浆细胞渗入血管壁。血栓形成出现在小静脉中。全身毒性改变包括肺、肝、肾、心脏和肾上腺实质细胞的变性和坏死。电子显微镜显示肺组织中有与冠状病毒一致的病毒颗粒簇。SARS是一种损害许多器官的全身性疾病。肺、免疫器官和全身小血管是病毒攻击的主要目标，因此肺广泛实变、弥漫性肺泡损伤和透明膜形成、呼吸窘迫和免疫功能下降是死亡的主要原因。版权所有(C)2003 John Wiley Sons，Ltd.
In order to investigate the clinical pathology of severe acute respiratory syndrome (SARS), the autopsies of three patients who died from SARS in Nan Fang Hospital Guangdong, China were studied retrospectively. Routine haematoxylin and eosin (H&E) staining was used to study all of the tissues from the three cases. The lung tissue specimens were studied further with Macchiavello staining, viral inclusion body staining, reticulin staining, PAS staining, immunohistochemistry, ultrathin sectioning and staining, light microscopy, and transmission electron microscopy. The first symptom was hyperpyrexia in all three cases, followed by progressive dyspnoea and lung field shadowing. The pulmonary lesions included bilateral extensive consolidation, localized haemorrhage and necrosis, desquamative pulmonary alveolitis and bronchitis, proliferation and desquamation of alveolar epithelial cells, exudation of protein and monocytes, lymphocytes and plasma cells in alveoli, hyaline membrane formation, and viral inclusion bodies in alveolar epithelial cells. There was also massive necrosis of splenic lymphoid tissue and localized necrosis in lymph nodes. Systemic vasculitis included oedema, localized fibrinoid necrosis, and infiltration of monocytes, lymphocytes, and plasma cells into vessel walls in the heart, lung, liver, kidney, adrenal gland, and the stroma of striated muscles. Thrombosis was present in small veins. Systemic toxic changes included degeneration and necrosis of the parenchyma cells in the lung, liver, kidney, heart, and adrenal gland. Electron microscopy demonstrated clusters of viral particles, consistent with coronavirus, in lung tissue. SARS is a systemic disease that injures many organs. The lungs, immune organs, and systemic small vessels are the main targets of virus attack, so that extensive consolidation of the lung, diffuse alveolar damage with hyaline membrane formation, respiratory distress, and decreased immune function are the main causes of death. Copyright (C) 2003 John Wiley Sons, Ltd.