浅谈急性传染性非典型肺炎病理学及发病机制

严重急性呼吸综合征(severe actue respiratory syndrome,SARS),我国暂命名为急性传染性非典型肺炎(acute inffectionus atypieal pneumonia,AIAP),简称非典型肺炎(AP)是近几个月流行全球30余个国家和地区的一种急性传染病,该病来势凶险,传染性极强,是目前国际医学界研究的焦点,本文作者根据4例系统尸体解剖和2例会诊资料对SARS的病理学特点及其发病机制作简要概述.本研究发现SARS的病理变化主要包括肺部病变,免疫器官损伤,全身小静脉炎,全身中毒性改变和继发感染4个方面.肺部病变主要包括肺水肿、肺泡上皮增生、融合、脱落、凋亡呈脱屑性肺炎变化,局灶性出血坏死,局灶性肾小球状机化性肺炎,大量肺透明膜形成,肺泡上皮内可见病毒包涵体及病毒性颗粒;免疫器官损伤,脾脏淋巴组织大片状坏死,淋巴结灶性坏死;全身小静脉炎;全身多器官内小静脉周围及血管壁水肿,灶性纤维素样坏死,单核细胞及淋巴细胞浸润,部分小静脉内有血栓形成;全身中毒性变化和继发感染;全身多器官实质细胞变性坏死和继发霉菌感染.肺和免疫器官是SARS病毒攻击的主要靶器官.SARS的发病机制不清,可能与SARS病毒进入机体后通过两种方式影响宿主有关:①SARS病毒进入靶细胞诱导细胞凋亡;②SARS诱导机体的免疫反应,引起组织和器官的病变.

Primary discussion on etiology and pathogenesis of servere acute respiratory syndrome

Severe acute respiratory syndrome (SARS) is an acute infectious disease which has been found to spread mainly via respiration in 30 countries and areas of the world. The disease was referred to as acute infectious atypical pneumonia (AIAP) in our country at first. It was a severe and acute disease with strong infection. At present, medical workers are studying it around the world. Here the author primarily discussed the pathological characteristics and pathogenesis of SARS according to the data of 4 systematic autopsy cases and 2 consultation cases. Our study found that pathological changes of SARS can bye summarized in terms of the four aspects: pulmonary lesions, lesions of immune organs, systemic vasculitis and systemic toxic reaction and secondary fungi infection. The pulmonary lesions mainly included edema, proliferation, desquamation, apoptosis, neurosis, syncytia of pnenmocytes, local glomeru-loid organizing pneumonia in later period, extensive hyaline membrane formed in alveoli. Viral inclusion and particles were seen in the plasma of some pnenmocytes; lesions of immune organs were massive necrosis of lymph tissue in spleen and olcal necrosis in lympho nodes. Systemic vasculitis included edema, localized fibronoid necrosis, infiltration of monoaytes and lymphoates in small vein circums-ference and vascular walls. Thrombosis formed in parts of small veins, Systemic toxic changes and secondary fungi infection included degeneration, necrosis of parachymal cells in multi - organs of all bodies. Lungs and immune organs are the main targets attacked by SARS virus. Now the pathogenesis of SARS is not clear, it may attribute to two ways to affect hosts after virus invade: 1. SARS virus enters target cells and induce cell to apoptosis; 2. SARS virus activate immune system of host to cause lesions of tissues and organs.