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COVID-19感染逝者尸检的组织病理学和超微结构分析
作者:小柯机器人 发布时间:2020/7/22 15:28:30

美国华盛顿大学Benjamin T Bradley团队对COVID-19感染逝者进行了组织病理学和超微结构分析。该研究于2020年7月16日发表在《柳叶刀》杂志上。

SARS-CoV-2是疫情持续大流行的原因,全球死亡人数逐步增加。到目前为止,由于缺乏尸检和不完整的器官采样,关于SARS-CoV-2(COVID-19)致死病例的组织病理学特征的记录很少。

为了提供重症COVID-19病例的临床病理学报告,并记录SARS-CoV-2组织嗜性的证据,研究组招募了14例生前或死后SARS-CoV-2结果呈阳性的患者,2020年2月和3月在华盛顿州两处法医办公室的负压隔离点对这14名死于COVID-19的患者进行了尸检。对患者的临床和实验室资料进行回顾。采用光镜、免疫组化、电镜和定量RT-PCR进行组织检查。

14例逝者的中位年龄为73.5岁。所有患者都有临床上显著的合并症,最常见的是高血压、慢性肾脏疾病、阻塞性睡眠呼吸暂停和包括糖尿病和肥胖症在内的代谢性疾病。主要肺部发现为急性或组织期的弥漫性肺泡损伤,其中5名患者表现出局灶性肺微血栓。在呼吸系统、肾脏和胃肠道中检测到新冠病毒样颗粒。在1名患者中观察到淋巴细胞性心肌炎,并在组织中检测到病毒RNA。

总之,研究组观察到的主要病理是弥漫性肺泡损伤,病毒位于肺细胞和气管上皮中。微血栓稀少,未发现内皮炎。尽管其他非肺脏器官对感染表现出易感性,但它们在SARS-CoV-2感染发病机制的作用尚需进一步分析。

附:英文原文

Title: Histopathology and ultrastructural findings of fatal COVID-19 infections in Washington State: a case series

Author: Benjamin T Bradley, Heather Maioli, Robert Johnston, Irfan Chaudhry, Susan L Fink, Haodong Xu, Behzad Najafian, Gail Deutsch, J Matthew Lacy, Timothy Williams, Nicole Yarid, Desiree A Marshall

Issue&Volume: 2020-07-16

Abstract: Background

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of an ongoing pandemic, with increasing deaths worldwide. To date, documentation of the histopathological features in fatal cases of the disease caused by SARS-CoV-2 (COVID-19) has been scarce due to sparse autopsy performance and incomplete organ sampling. We aimed to provide a clinicopathological report of severe COVID-19 cases by documenting histopathological changes and evidence of SARS-CoV-2 tissue tropism.

Methods

In this case series, patients with a positive antemortem or post-mortem SARS-CoV-2 result were considered eligible for enrolment. Post-mortem examinations were done on 14 people who died with COVID-19 at the King County Medical Examiner's Office (Seattle, WA, USA) and Snohomish County Medical Examiner's Office (Everett, WA, USA) in negative-pressure isolation suites during February and March, 2020. Clinical and laboratory data were reviewed. Tissue examination was done by light microscopy, immunohistochemistry, electron microscopy, and quantitative RT-PCR.

Findings

The median age of our cohort was 73·5 years (range 42–84; IQR 67·5–77·25). All patients had clinically significant comorbidities, the most common being hypertension, chronic kidney disease, obstructive sleep apnoea, and metabolic disease including diabetes and obesity. The major pulmonary finding was diffuse alveolar damage in the acute or organising phases, with five patients showing focal pulmonary microthrombi. Coronavirus-like particles were detected in the respiratory system, kidney, and gastrointestinal tract. Lymphocytic myocarditis was observed in one patient with viral RNA detected in the tissue.

Interpretation

The primary pathology observed in our cohort was diffuse alveolar damage, with virus located in the pneumocytes and tracheal epithelium. Microthrombi, where observed, were scarce and endotheliitis was not identified. Although other non-pulmonary organs showed susceptibility to infection, their contribution to the pathogenesis of SARS-CoV-2 infection requires further examination.

DOI: 10.1016/S0140-6736(20)31305-2

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31305-2/fulltext

期刊信息

LANCET:《柳叶刀》,创刊于1823年。隶属于爱思唯尔出版社,最新IF:59.102
官方网址:http://www.thelancet.com/
投稿链接:http://ees.elsevier.com/thelancet