美国哈佛大学Steven J. Mentzer等研究人员发现，新冠病毒病（Covid-19）可导致肺血管内皮炎、血栓形成和血管生成。2020年5月21日，国际知名学术期刊《新英格兰医学杂志》发表了这一成果。

Title: Pulmonary Vascular Endothelialitis, Thrombosis, and Angiogenesis in Covid-19

Author: Maximilian Ackermann, M.D.,, Stijn E. Verleden, Ph.D.,, Mark Kuehnel, Ph.D.,, Axel Haverich, M.D.,, Tobias Welte, M.D.,, Florian Laenger, M.D.,, Arno Vanstapel, Ph.D.,, Christopher Werlein, M.D.,, Helge Stark, Ph.D.,, Alexandar Tzankov, M.D.,, William W. Li, M.D.,, Vincent W. Li, M.D.,, Steven J. Mentzer, M.D.,, and Danny Jonigk, M.D.

Issue&Volume: 2020-05-21

Abstract: BACKGROUND

Progressive respiratory failure is the primary cause of death in the coronavirus disease 2019 (Covid-19) pandemic. Despite widespread interest in the pathophysiology of the disease, relatively little is known about the associated morphologic and molecular changes in the peripheral lung of patients who die from Covid-19.

METHODS

We examined 7 lungs obtained during autopsy from patients who died from Covid-19 and compared them with 7 lungs obtained during autopsy from patients who died from acute respiratory distress syndrome (ARDS) secondary to influenza A(H1N1) infection and 10 age-matched, uninfected control lungs. The lungs were studied with the use of seven-color immunohistochemical analysis, micro–computed tomographic imaging, scanning electron microscopy, corrosion casting, and direct multiplexed measurement of gene expression.

RESULTS

In patients who died from Covid-19–associated or influenza-associated respiratory failure, the histologic pattern in the peripheral lung was diffuse alveolar damage with perivascular T-cell infiltration. The lungs from patients with Covid-19 also showed distinctive vascular features, consisting of severe endothelial injury associated with the presence of intracellular virus and disrupted cell membranes. Histologic analysis of pulmonary vessels in patients with Covid-19 showed widespread thrombosis with microangiopathy. Alveolar capillary microthrombi were 9 times as prevalent in patients with Covid-19 as in patients with influenza (P<0.001). In lungs from patients with Covid-19, the amount of new vessel growth — predominantly through a mechanism of intussusceptive angiogenesis — was 2.7 times as high as that in the lungs from patients with influenza (P<0.001).

CONCLUSIONS

In our small series, vascular angiogenesis distinguished the pulmonary pathobiology of Covid-19 from that of equally severe influenza virus infection. The universality and clinical implications of our observations require further research to define.

DOI: 10.1056/NEJMoa2015432

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2015432