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目的:探讨不同时间SARS死亡患者肺纤维化的病变经历过程及特点。方法:以6例SARS死亡患者(分别于发病后9,14,20,29,33,38 d死亡)肺标本为对象,应用常规HE染色、三联染色、苦味酸-天狼猩红-偏振光法和电镜等技术方法,观察SARS肺组织的病理变化和纤维化的病理过程以及胶原纤维、网状纤维和弹力纤维的变化特点、Ⅰ型与Ⅲ型胶原纤维分布规律及其超微结构变化。结果:SARS发病后于9~38 d死亡的6例患者肺脏出现程度不等的成纤维细胞变化和纤维组织增生,其中2例(33,38 d)发生典型的肺纤维化病变。肺间质组织和成纤维细胞变化可大致分为4种类型:成纤维细胞轻度活跃型,见于9,14 d死亡例;成纤维细胞增生型,见于20 d死亡例;纤维组织增生型,见于29 d死亡例;纤维化形成型,见于33,38 d死亡例。经三联染色和天狼猩红染色证实,纤维增生以胶原为主,其中Ⅰ型胶原增生较Ⅲ型胶原明显。结论:初步认为,肺脏4种类型病变本质上反映了SARS肺纤维化的发生发展过程,可能经历4个阶段,即:成纤维细胞轻度活跃期、成纤维细胞增生期、纤维组织增生期和纤维化形成期。SARS肺纤维化病变特点为:(1)纤维化出现较早(33 d);(2)纤维化病变呈进行性发展;(3)以Ⅰ型胶原纤维为主;⑷局灶性分布突出。
Objective: To investigate the course and characteristics of pulmonary fibrosis in patients with SARS death at different time points. Methods: The lung specimens of 6 patients died of SARS (died at 9, 14, 20, 29, 33 and 38 days after onset) were selected for the study. HE staining, triple staining, picric acid - Sirius red - And electron microscopy. The pathological changes of lung tissue and the pathological process of fibrosis were observed. The changes of collagen fibers, reticular fibers and elastic fibers, the distribution of type I and type III collagen fibers and their ultrastructural changes were observed. Results: The lungs of 6 patients died from 9 to 38 days after onset of SARS showed varying degrees of fibroblast changes and fibrous tissue proliferation. Two cases (33 and 38 days) had typical pulmonary fibrosis. Pulmonary interstitial tissue and fibroblast changes can be divided into four types: mildly active fibroblasts, found in 9,14 d deaths; fibroblast hyperplasia, seen in 20 d death cases; fibrous tissue hyperplasia, Found at 29 d deaths; fibrosis, seen at 33,38 d deaths. The triple staining and Sirius red staining confirmed that fibrosis mainly collagen, in which type Ⅰ collagen hyperplasia than type Ⅲ collagen obvious. CONCLUSIONS: It is preliminarily believed that the four types of pulmonary lesions essentially reflect the occurrence and development of pulmonary fibrosis in SARS and may undergo four stages: mild active fibroblast stage, fibroblast hyperplasia stage, fibrous tissue hyperplasia stage and Fibrosis formation period. SARS pulmonary fibrosis lesions are as follows: (1) fibrosis appeared earlier (33 d); (2) fibrosis lesions progressed; (3) type Ⅰ collagen fibers; (4) prominent focal distribution.