目的 研究重症急性呼吸综合征(SARS)的临床病理学特点。方法 利用3例尸检材料为观察对象,全部材料经常规HE染色,肺组织部分标本经组织化学Macchiavello法(病毒包涵体染色)、网状纤维、PAS染色;免疫组织化学;超薄切片及染色;光镜及透射电镜观察。结果 3例均以高热为首发症状,继而出现进行性呼吸困难和肺部阴影;肺部病变:双肺广泛性实变;灶性出血,坏死,脱屑性肺泡炎及支气管炎,肺泡腔内充满增生脱落的肺泡上皮及渗出的蛋白、单核细胞、淋巴细胞和浆细胞,肺透明膜形成,部分肺泡腔内、渗出物机化呈肾小球样机化性肺炎改变,肺泡上皮细胞内可见病毒包涵体;免疫器官损伤:脾脏淋巴组织大片状坏死,淋巴结灶性坏死。骨髓造血组织抑制;全身小血管炎:心、肺、肝、肾、肾上腺、横纹肌间小静脉周围及血管壁水肿,灶性纤维素样坏死,单核细胞、淋巴细胞浸润,部分小静脉有血栓形成;全身中毒性改变:肺、肝、肾、心、肾上腺实质细胞变性,坏死。肺组织透射电镜观察发现群集的病毒颗粒。结论 本病是一种全身多器官损伤性疾病,肺部及免疫系统是病毒主要作用的靶器官,肺部广泛性实变,大量透明膜形成,呼吸窘迫及免疫功能低下是本病死亡的主要原因。 Objective To study the clinicopathological features of severe acute respiratory syndrome (SARS). Methods Three autopsy specimens were used for the observation. All the materials were routinely stained with HE. Some of the lung tissues were stained with Macchiavello method by histochemistry (staining of virus inclusions), reticular fibers and PAS staining, immunohistochemistry, ultrathin sections and staining. Light and transmission electron microscopy. Results High fever was the first symptom in all three cases, followed by progressive dyspnea and pulmonary shadows. Pulmonary disease: extensive consolidation of both lungs; focal hemorrhage, necrosis, desquamative alveolitis and bronchitis, Alveolar epithelium and exudative protein, monocytes, lymphocytes and plasma cells filled with hyperplasia and exfoliation, the formation of transparent membrane of the lung, part of the alveolar space, and the exudate mechanization showed the change of glomerular mimotope pneumonia, the change of the alveolar epithelial cells Within the visible virus inclusions; Immune organ damage: large splenic lymphoid tissue necrosis, focal necrosis of lymph nodes. Bone marrow hematopoietic tissue inhibition; systemic small vasculitis: heart, lung, liver, kidney, adrenal, striated muscle around the small veins and vessel wall edema, focal fibrosis, monocytes, lymphocyte infiltration, some small venous thrombosis Formation; systemic toxic changes: lung, liver, kidney, heart, adrenal gland cells degeneration and necrosis. Lung tissue TEM observation revealed clusters of viral particles. Conclusions The disease is a systemic multiple organ damage. The lungs and immune system are the main target organs of the virus. Extensive consolidation of the lungs, formation of a large number of transparent membranes, respiratory distress and immunocompromise are the major causes of death the reason.