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目的 探讨重症急性呼吸综合征 (SARS)的死因和病变特征。方法 常规HE染色 ,组织化学Macchiavello法、MSB、网状纤维、PAS染色法进行观察。结果 SARS增生修复期改变 ;继发性肺曲菌病伴双肺广泛化脓性炎 ,严重的肺组织破坏 ,肺水肿 ,肺出血 ,气管、支气管、小支气管血液吸入 ;霉菌性败血症伴全身器官播散性、多发性曲菌性脓肿、局部组织坏死及出血伴纤维素性坏死性血管炎、血栓及霉菌菌栓形成 ;免疫器官抑制 :脾红髓及白髓等淋巴组织严重减少 ,淋巴组织灶状坏死 ;纤维组织增生 ;淋巴结淋巴滤泡减少 ,生发中心消失 ,间质纤维化 ;骨髓粒细胞系、巨核细胞系减少 ,红细胞系灶状增生。结论 患者死于免疫功能抑制继发感染性多器官衰竭。提示对SARS的皮质激素治疗要适时视情慎用。
Objective To investigate the causes and pathological features of severe acute respiratory syndrome (SARS). Methods HE staining, histochemical Macchiavello method, MSB, reticular fibers, PAS staining were observed. The results of SARS proliferative repair phase changes; secondary pulmonary aspergillosis with extensive lung suppurative inflammation, severe lung tissue destruction, pulmonary edema, pulmonary hemorrhage, trachea, bronchi, bronchial blood inhalation; fungal sepsis with whole body organ broadcast Diffuse, multiple fungal abscesses, local tissue necrosis and hemorrhage with fibrotic necrotizing vasculitis, thrombosis and mold plug formation; immune organ suppression: spleen red pulp and white pulp and other lymphoid tissue was significantly reduced, lymphoid tissue-like Necrosis; fibrosis; lymph node follicles reduced, germinal center disappeared, interstitial fibrosis; bone marrow granulocyte cell line, megakaryocyte cell line, erythroid cell lineage hyperplasia. Conclusions The patient died of immune function suppression secondary to infectious multiple organ failure. Prompt corticosteroid treatment of SARS should be timely and with caution.