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目的 系统观察 6例严重急性呼吸综合征(SARS)不同时间死亡患者近 30个脏器的病理变化 ,探讨其病理发生发展过程及病变和病原体特点。方法 采用光镜、透射电镜、组织化学和部分免疫组织化学方法观察各脏器的病理变化。结果 ①重症SARS死亡患者早期基本病变为以肺和免疫器官 (脾、淋巴结、黏膜淋巴组织)为主的全身各脏器发生不同程度的实质细胞变性、凋亡和坏死等变质性改变和肺水肿、透明膜形成及出血等为主的血循环障碍 ;中后期则以肺上皮坏死脱落和间质纤维增生伴早期纤维化及免疫器官进行性萎缩等病变为主 ,再次证实肺和免疫器官为主要靶器官 ;②肺脏病变经历急性渗漏性炎症期 (发病后 2周内 ,主要病变为严重的弥漫性肺水肿和透明膜形成)、肺泡上皮坏死脱落伴增生机化性炎症期 (发病后 3～ 4周 )和纤维增生伴早期纤维化期 (发病后 5～ 6周 ) ,具有广泛性、速发性、进行性和阶段性、多样性等特点 ;③在重症SARS死亡患者中 ,脾和淋巴结等免疫器官发生严重的破坏和广泛出血 ,脾小体和淋巴滤泡极度萎缩 ,淋巴细胞迅速发生凋亡和坏死 ,T、B淋巴细胞数量极度减少 ,免疫功能极度低下 ,其病变同样具有广泛性、速发性和持续性等特点 ;④证实主要病原体为新型冠状病毒 ,衣原体样颗粒也是致病病原体之一 ,同时
Objective To observe the pathological changes of nearly 30 organs in 6 patients with severe acute respiratory syndrome (SARS) death at different time, and to explore the pathological development process, pathogenesis and pathogenic features. Methods The pathological changes of various organs were observed by light microscope, transmission electron microscope, histochemistry and immunohistochemistry. Results ① In the early stage of severe SARS death, the basic lesion was characterized by various degrees of parenchymal degeneration, apoptosis and necrosis, and pulmonary edema in various organs of the body including lung and immune organs (spleen, lymph node and mucosal lymphoid tissue) , The formation of transparent membrane and bleeding-based circulatory disorders; the latter part of the lung epithelial necrosis and interstitial fibrosis with early fibrosis and immune organ atrophy and other lesions based mainly confirmed again lung and immune organs as the main target (2 weeks after onset, the main lesion is severe diffuse pulmonary edema and hyaline membrane formation), alveolar epithelial necrosis with proliferative inflammatory reaction (3 ~ 4 weeks) and fibrosis with early fibrosis (5 to 6 weeks after onset), with a wide range of rapid onset, progressive and stage, diversity and other characteristics; ③ in patients with severe SARS death, spleen and lymph nodes Serious damage to the immune organs and extensive bleeding, the spleen and lymphoid follicles extremely atrophy, rapid apoptosis of lymphocytes and necrosis, T, B lymphocyte number of very Reduced immune function extremely low, which also has extensive lesions, fast onset and persistence characteristics; ④ confirmed major pathogens of novel coronavirus, chlamydia-like particle is one of the causative pathogens, while