论文部分内容阅读
目的 研究非典型肺炎 /严重的急性呼吸综合征 (SARS)的病理学特点 ,并探讨其病原 ,为临床防治提供依据。方法 采用光镜、透射电镜、组织化学和免疫组织化学技术方法 ,对 1例地方SARS死亡病例 (属国家卫生部公布的死亡病例之一 )进行观察研究。结果 该例SARS的肺部病变为严重的急性间质性渗漏出性炎 ,肺泡间隔为以淋巴细胞为主的炎细胞浸润 ,伴 2 0 %～ 30 %肺泡腔内透明膜形成 ;弥漫性肺泡上皮损伤 ,呈凋亡及脱失改变 ;光镜下偶见肺泡上皮内病毒包涵体样结构 ;组织化学染色显示 ,超过 30 %的肺泡上皮细胞病毒包涵体染色阳性 ,而衣原体包涵体染色阳性细胞不足 5 %。肺外器官主要表现为淋巴结、脾脏等免疫器官较广泛的出血坏死性炎 ,组织细胞反应性增生及噬红细胞现象 ,双侧肾上腺局灶性出血坏死性炎。电镜观察 ,肺组织内I、II型肺泡上皮细胞、血管内皮细胞 ,部分心肌细胞及淋巴结内组织细胞和淋巴细胞内均查见较多病毒样颗粒 ,大小为 10 0～ 15 0nm ,有光晕或花环状包膜 ,病毒样颗粒主要分布于细胞胞质内 ,少部分见于扩张的内质网内 ;肺外肝等组织内较易查见衣原体样颗粒 ,但肺泡组织内鲜见。死者本人及源自广东省的SARS患者恢复期血清IgM和 (或 )IgG与其肺组织呈阳性反应。结论 肺部明显的急性间质?
Objective To study the pathological features of atypical pneumonia / severe acute respiratory syndrome (SARS) and to explore its pathogeny for clinical prevention and treatment. Methods One case of death from SARS (one of the deaths reported by the Ministry of Health) was studied by light microscopy, transmission electron microscopy, histochemistry and immunohistochemistry. Results The pulmonary disease in this case of SARS was severe acute interstitial leucorrhea. The alveolar septum was infiltrated with lymphocyte predominant inflammatory cells and formed with 20% -30% of alveolar clear membrane. The diffuse Alveolar epithelial injury, apoptosis and loss of change; light microscopy of alveolar epithelial virus inclusion bodies occasionally seen; histochemical staining showed that more than 30% of alveolar epithelial cells were positive staining for inclusion bodies, and positive for inclusion bodies of Chlamydia staining Less than 5% of cells. Extrapulmonary organs mainly for lymph nodes, spleen and other immune organs more extensive hemorrhagic necrosis inflammation, tissue hyperplasia and erythropolis red blood cell phenomenon, bilateral adrenal hemorrhagic necrosis. Electron microscopy showed that more virus-like particles were found in type I and type II alveolar epithelial cells, vascular endothelial cells, some cardiomyocytes, and lymphoid tissues and lymphocytes in the lung tissues, ranging in size from 10 0 to 150 nm with a halo Or enveloping envelope, virus-like particles are mainly distributed in the cytoplasm of the cell, a small part found in the expansion of the endoplasmic reticulum; extrahepatic livers and other tissues easier to find chlamydia-like particles, but alveolar tissue rare. The convalescent serum IgM and / or IgG in the deceased and those with SARS originating in Guangdong province were positive for lung cancer. Conclusion Pulmonary obvious acute stroma?