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[Lancet Infect Dis发表论文]:意大利北部新冠病毒感染病例肺部尸检发现
2020年11月19日 时讯速递, 进展交流 暂无评论

ARTICLES| VOLUME 20, ISSUE 10, P1135-1140, OCTOBER 01, 2020

Pulmonary post-mortem findings in a series of COVID-19 cases from northern Italy: a two-centre descriptive study

Luca Carsana, Aurelio Sonzogni, Ahmed Nasr, et al

Lancet Infect Dis 2020; 20: 1135-1140

Summary 摘要

Background 背景

COVID-19 is characterised by respiratory symptoms, which deteriorate into respiratory failure in a substantial proportion of cases, requiring intensive care in up to a third of patients admitted to hospital. Analysis of the pathological features in the lung tissues of patients who have died with COVID-19 could help us to understand the disease pathogenesis and clinical outcomes.

COVID-19的特征为呼吸道症状,相当多的病例可进展为呼吸功能衰竭,多达1/3的住院患者需要入住ICU。对死于COVID-19的患者肺组织进行病理分析,有助于了解疾病发病机制及临床预后。

Methods 方法

We systematically analysed lung tissue samples from 38 patients who died from COVID-19 in two hospitals in northern Italy between Feb 29 and March 24, 2020. The most representative areas identified at macroscopic examination were selected, and tissue blocks (median seven, range five to nine) were taken from each lung and fixed in 10% buffered formalin for at least 48 h. Tissues were assessed with use of haematoxylin and eosin staining, immunohistochemical staining for inflammatory infiltrate and cellular components (including staining with antibodies against CD68, CD3, CD45, CD61, TTF1, p40, and Ki-67), and electron microscopy to identify virion localisation.

我们对2020年2月29日至3月24日意大利北部2家医院38例COVID-19死亡患者的肺组织标本进行了系统分析。选择大体检查下最有代表性的区域,对每侧肺取组织块(中位数7,范围5-9),10%福尔马林固定至少48小时。对肺组织标本进行HE染色,以及免疫组化染色分析炎性浸润和细胞成分(包括CD68, CD3, CD45, CD61, TTF1, p40, 和 Ki-67 抗体染色),并进行电镜检查确定病毒颗粒位置。

Findings 结果

All cases showed features of the exudative and proliferative phases of diffuse alveolar damage, which included capillary congestion (in all cases), necrosis of pneumocytes (in all cases), hyaline membranes (in 33 cases), interstitial and intra-alveolar oedema (in 37 cases), type 2 pneumocyte hyperplasia (in all cases), squamous metaplasia with atypia (in 21 cases), and platelet–fibrin thrombi (in 33 cases). The inflammatory infiltrate, observed in all cases, was largely composed of macrophages in the alveolar lumina (in 24 cases) and lymphocytes in the interstitium (in 31 cases). Electron microscopy revealed that viral particles were predominantly located in the pneumocytes.

所有病例均表现为弥漫性肺泡损伤的渗出期和增殖期的特征,包括毛细血管充血(33例),间质和肺泡内水肿(37例),2型肺泡细胞增生(所有病例),鳞状花生伴异型性(21例),以及血小板-纤维素血栓(33例)。所有病例均观察到炎性浸润,主要由肺泡腔内巨噬细胞(24例)和间质内淋巴细胞(31例)组成。电镜显示病毒颗粒主要位于肺泡上皮细胞内。

Interpretation 结论

The predominant pattern of lung lesions in patients with COVID-19 patients is diffuse alveolar damage, as described in patients infected with severe acute respiratory syndrome and Middle East respiratory syndrome coronaviruses. Hyaline membrane formation and pneumocyte atypical hyperplasia are frequent. Importantly, the presence of platelet–fibrin thrombi in small arterial vessels is consistent with coagulopathy, which appears to be common in patients with COVID-19 and should be one of the main targets of therapy.

与SARS和MERS患者相同,COVID-19患者肺部病变的主要表现为弥漫性肺泡损伤。透明膜形成及肺泡上皮细胞不典型增生非常普遍。重要的是,小血管中的血小板-纤维素血栓符合凝血功能异常的表现,后者是COVID-19患者的常见表现,应当作为治疗的主要目标。

Funding 资助

None.

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