Pulmonary post-mortem findings in a series of COVID-19 cases from northern Italy: a two-centre descriptive study
Pulmonary post-mortem findings in a series of COVID-19 cases from northern Italy: a two-centre descriptive study
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DOI：
10.1016/s1473-3099(20)30434-5
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发表时间：
2020-10-01
影响因子：
56.3
通讯作者：
Nebuloni, Manuela
中科院分区：
文献类型：
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作者：
Carsana, Luca;Sonzogni, Aurelio;Nebuloni, Manuela
背景COVID-19的特征是呼吸道症状，在很大一部分病例中会恶化为呼吸衰竭，在入院的患者中，多达三分之一需要重症监护。分析死于COVID-19的患者的肺组织病理特征有助于我们了解疾病发病机制和临床结局。方法我们系统分析了2020年2月29日至3月24日期间在北方意大利两家医院死于COVID-19的38例患者的肺组织样本。选择肉眼检查时识别的最具代表性的区域，从每个肺中采集组织块（中位数7个，范围5 - 9个），并在10%福尔马林缓冲液中固定至少48 h。采用苏木精-伊红染色、免疫组化染色检测组织中的炎症浸润和细胞成分（包括用抗CD 68、CD 3、CD 45、CD 61、TTF 1、p40和Ki-67的抗体染色）和电子显微镜鉴定病毒粒子定位。包括毛细血管充血（所有病例）、肺泡细胞坏死（所有病例）、透明膜（33例）、间质和肺泡内水肿（37例）、2型肺泡细胞增生（所有病例）、鳞状上皮化生伴肺泡炎（21例）和血小板-纤维蛋白血栓（33例）。在所有病例中观察到的炎性浸润主要由肺泡腔中的巨噬细胞（24例）和肺泡中的淋巴细胞（31例）组成。电子显微镜显示病毒颗粒主要位于肺细胞中。解释COVID-19患者肺部病变的主要模式是弥漫性肺泡损伤，与感染严重急性呼吸综合征和中东呼吸综合征冠状病毒的患者相同。肺透明膜形成和肺细胞不典型增生是常见的。重要的是，小动脉血管中血小板-纤维蛋白血栓的存在与凝血功能障碍一致，凝血功能障碍似乎在COVID-19患者中很常见，应该是治疗的主要目标之一。版权所有（C）2020爱思唯尔有限公司保留所有权利。
Background 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.Methods 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.Findings 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.Interpretation 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. Copyright (C) 2020 Elsevier Ltd. All rights reserved.