SARS肺的病理鉴别诊断

目的 分析严重急性呼吸综合征(severe acute respiratory syndrome，SARS)肺部病变的临床病理形态学特征及与其他肺部炎性疾病的鉴别诊断。方法 对3例行尸体解剖的SARS病例的肺组织进行组织形态学、免疫组织化学和电镜下超微结构的观察，对其临床表现、病理形态学特征及主要鉴别诊断进行探讨，并与病理资料完整的16例病毒性肺炎、13例间质性肺炎的肺部病变进行鉴别诊断。结果 死亡的SARS病人肺部病变主要表现为弥漫性的肺部损伤，但是各处病变轻重不一。肺泡腔内可见细颗粒样或泡状水肿液，其中可见脱落的肺泡上皮细胞。肺泡间隔表面可见透明膜覆盖，有的区域肺泡腔内出现机化性改变，肺泡腔和肺问质内可见大量的巨噬细胞浸润。同时，肺间质内的小动脉壁出现明显的损伤性改变。结论 SARS的肺部病理形态学特征可与其他肺部炎症性疾病鉴别。

Pathological diagnosis and differential diagnosis of severe acute respiratory syndrome

Purpose To evaluate the histopathological characteristics of severe acute respiratory syndrome (SARS) and to analysis the differential diagnosis of SARS from other similar diseases of the lung. Methods Three cases of SARS were observed with histopathology,immunohistochemistry and ultrastructures under scanning electron microscope. Clinical manification, histopathological features were compared with 16 cases of viral pneumonia and 13 interstitial pneumonias in order to make differential diagnosis. Results The pulmonary changes of postmortem SARS patient who underwent autopsy included hyaline membrane formation, interstitial mononuclear inflammatory infiltrates, and desquamation of pneumocytes in alveolar spaces There were also scattered foci of organizing pneumonitis developed. Interalveolar septa were mildly thickened, with a mild mononuclear infiltrate. Another notable characteristic change was acute necrotizing vasculitis. Conclusions With combination of clinical manifestation and histopathological features, SARS can be differentiated from other similar lung diseases.