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目的:探讨 SARS 肺脏及全身多脏器超微结构病变的特点及意义。方法:6例 SARS 尸检标本超薄切片,透射电子显微镜观察。结果:SARS 患者全身多个脏器中都存在着不同形态的冠状病毒样颗粒,包括肺、心、肝、肾、胃、脾、淋巴结及睾丸。而在脑、肠道、胰腺及甲状腺等器官仅在血管内皮中发现冠状病毒样颗粒。肺脏主要超微病变为肺泡Ⅰ型上皮脱落、基底膜裸露破坏,肺泡Ⅱ型上皮增生,纤维蛋白颗粒构成透明膜,毛细血管内皮肿胀及通透性增加,病程较长病例出现间质纤维化。脾脏与淋巴结中树突状细胞萎缩失活,淋巴细胞大量凋亡及溶解坏死,单核吞噬细胞系统细胞肿胀变性和机能减退。全身其它脏器的实质细胞多呈线粒体与内质网肿胀扩张及空泡变性,还可见凋亡与坏死改变。全身所有器官组织中的内皮细胞都呈高度水肿、空泡变性及连接结构破坏,而且在内皮基质中多含有大量的冠状病毒样颗粒。结论:冠状病毒在人体内具有多种形态和较广泛的侵袭性,并具有强烈的嗜血管性。血管内皮损伤是肺脏、免疫器官及全身器官病变的重要基础。
Objective: To investigate the characteristics and significance of ultrastructural lesions of lung and systemic multiple organ in SARS. Methods: Ultrasonographic sections of 6 SARS autopsy specimens were observed by transmission electron microscopy. Results: Different forms of coronavirus-like particles, including lung, heart, liver, kidney, stomach, spleen, lymph nodes and testis, were present in multiple organs of SARS patients. In the brain, intestine, pancreas and thyroid and other organs found only in the vascular endothelial coronavirus-like particles. The main pathological changes of the lungs were alveolar type I epithelial detachment, bare basement membrane destruction, alveolar type II epithelial hyperplasia, fibrin granule formed a transparent membrane, capillary endothelial swelling and permeability increased, longer course of disease appeared interstitial fibrosis. Dendritic cells in spleen and lymph node atrophy inactivation, a large number of lymphocytes apoptosis and lytic necrosis, mononuclear phagocyte system cell degeneration and degeneration. Other organs of the body most of the parenchyma cells were mostly mitochondria and endoplasmic reticulum swelling and vacuolar degeneration, but also the changes of apoptosis and necrosis can be seen. Endothelial cells in all organs of the body were highly edema, vacuolar degeneration and destruction of the junctional structure, but also in the endothelial matrix contains a large number of coronavirus-like particles. Conclusion: The coronavirus has a variety of morphological and more invasive in the human body, and has a strong viremic. Vascular endothelial injury is an important basis for lung, immune organs and systemic organ disease.