6 例SARS病理学及病原学观察

目的：探讨SARS病理学特点及病原学与临床的关系。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周病程早期的SARS死亡尸检病例和4例3—5周病程中晚期的SARS死亡病例进行观察研究。结果：电镜下冠状病毒样颗粒大小为60—220nm，呈多态性，还可见到衣原体样颗粒和疑似支原体样颗粒。SARS早期肺部病理改变为急性弥漫性肺泡损伤，肺水肿，广泛肺透明膜形成，脱屑性肺泡炎及小血管病变。SARS中晚期肺部病理改变以肺泡间质纤维增生和肺泡早期纤维化等机化性肺炎的表现为主要特征，同时有弥漫性肺泡损伤和脱屑性肺泡炎。结论：不同病程的SARS有不同的病理学特征。

Pathology and etiological observations of six SARS

Objective:To study the pathological and ultramicrostructural characteristics and etiology in relation to the clinical course of Severe Acute Respiratory Syndrome(SARS). Methods:Post-mortem tissue samples of multi-organs (lungs, heart, liver, spleen, kidneys, pancreas, stomach ) were taken by needle biopsy from four SARS patients who died at 3 - 5 weeks of middle and late stages .Systematic autopsy were carried on two SARS cases who died at 1-2 weeks of early stages. The pathological samples were studied by light and electron microscope, immuno- histochemistry, histochemistry and indirect immunofluorescent antibody test. Results:Electron microscopy showed the coronavirus-like particles with the diameter of 60 -220 nm and polymorphism. The chlamydia like particles and suspicious mycoplasma-like particles were observed in the lung and other organs.The main pathological features of 1-2 weeks of early stages of SARS were diffuse alveolar damage (DAD)with pulmonary edema and desquamative alveolitis .Hyaloid Membranes were formed extensively. The mainpathological featuresof 3 - 5 weeks of middle and late stages of SARSwerethe early interstitialpulmonary fibrosis or organizing pneumonia. Fibroblasts increased in the interalveoli septa and young connective tissue filled alveoli. Diffuse alveolar damage and desquamative alveolitis also existed. Conclusions: There were the different pathologicalfeatures in the different stages of SARS.