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目的探讨SARS超微病理学及病原学特点。方法应用透射电镜、光镜、组织化学和免疫学方法对2例1~2周病程的早期SARS死亡尸检病例和4例3~5周病程的中晚期SARS死亡病例进行观察研究。结果两组SARS病例肺泡Ⅱ型上皮细胞、血管内皮细胞,心肌细胞、肝窦内皮细胞、肾小管上皮细胞胞质和血液内冠状病毒样颗粒具有多态性,大小为60~220 nm,以具有低电子密度核心的A型病毒颗粒和高电子密度核心的C型病毒颗粒较为多见,偏心性高电子密度核心的B型病毒颗粒也可见到;还可以见到无明显包膜的病毒体样颗粒以及不规则形状的病毒颗粒。病程1~2周死亡病例主要为肺泡上皮细胞损伤性和增生性改变,板层小体减少,表面活性物质膜消失。病程3~5死亡病例以肺泡间质纤维增生和肺泡早期纤维化等为主要表现。肺泡隔间质中纤维母细胞增生明显,小血管壁增厚。Ⅱ型肺泡上皮细胞增生。结论SARS不同病程死亡病人的肺部超微结构改变有不同的特征。多个脏器内均见到冠状病毒样颗粒,主要损害肺脏和免疫器官。认识和研究SARS不同病程的超微病理学和病原学特点,将为SARS临床诊断和治疗提供重要的理论依据和病理学基础。
Objective To investigate the ultrastructural pathology and etiology of SARS. Methods Two cases of SARS death from one to two weeks course of disease and four cases of middle and late SARS death from three to five weeks course were observed by transmission electron microscopy, light microscopy, histochemistry and immunology. Results The results showed that there were polymorphisms in the type Ⅱ corneal epithelial cells, vascular endothelial cells, cardiomyocytes, sinusoidal endothelial cells, cytoplasmic and intrahepatic coronavirus-like particles in the two groups of SARS cases, ranging from 60 to 220 nm in size Type A virus particles of low electron density core and Type C virus particles of high electron density core are more common, and type B virus particles of high electron density core of eccentricity are also visible. Virosome-like samples without obvious envelope can also be seen Particles and irregularly shaped virus particles. Course of disease 1 to 2 weeks of deaths are mainly alveolar epithelial cell damage and proliferation changes, reduction of lamellar bodies, surfactant film disappears. Course of disease 3 to 5 deaths with alveolar interstitial fibrosis and early alveolar fibrosis as the main performance. Alveolar interstitial fibroblasts in the quality of proliferation, small blood vessel wall thickening. Type II alveolar epithelial cell hyperplasia. Conclusions The ultrastructural changes in the lungs of SARS patients with different pathological death have different characteristics. Coronavirus-like particles were seen in many organs, mainly damaging to the lungs and immune organs. To understand and study the pathological and pathological features of different stages of SARS will provide an important theoretical basis and pathological basis for the clinical diagnosis and treatment of SARS.