The histopathological features of the explanted lungs from an end-stage COVID-19 patient.
The histopathological features of the explanted lungs from an end-stage COVID-19 patient.
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终末期 COVID-19 患者移植肺的组织病理学特征
DOI：
10.1080/20961790.2020.1807128
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发表时间：
2020-09-01
影响因子：
1.3
通讯作者：
Su C
中科院分区：
文献类型：
--
作者：
Li K;Yu Y;Li D;Luan C;Hu L;Wang J;Ding J;Yu Y;Yang H;Chen J;Chen F;Su C
尽管之前的研究已经报道了2019冠状病毒病（COVID-19）与急性呼吸窘迫综合征（ARDS）相关的病理结果，但仍缺乏终末期COVID-19肺部的组织病理学特征数据。我们之前报道了三例肺功能不可逆恶化的COVID-19患者在体外膜肺氧合（ECMO）支持后接受肺移植（LT）的临床特征和治疗[1]。该患者的详细病史和治疗先前已报道过[1]。简而言之，该患者男性，73岁，有2型糖尿病、糖尿病肾病、慢性肾功能衰竭、冠状动脉粥样硬化性心脏病、心房颤动、慢性支气管炎、肺气肿和耳聋病史。 2020年2月2日，以发热、咳嗽为首发症状入院，经反向实时PCR检测确诊为COVID-19。患者在住院期间逐渐出现ARDS，并于2月20日接受气管切开和有创机械通气（MV）。2月21日建立静脉-静脉（VV）-ECMO。由于血清肌酸快速升高，2月26日开始连续性肾脏替代治疗（CRRT）。超声心动图（3月9日）显示右心室衰竭、双心房扩大（左心房直径，LAD 43mm）、轻度二尖瓣关闭不全、轻度主动脉关闭不全、中度三尖瓣关闭不全、左心室舒张功能降低（二尖瓣口E峰<A峰）和肺动脉压升高（三尖瓣环平面收缩期偏移，TAPSE 12mm；流量E波速度积分，TVIE峰值<A峰值；肺动脉收缩压，PASP 53 mmHg；射血分数56.01%）。鉴于自2月25日以来严重急性呼吸综合征冠状病毒（SARS-CoV-2）咽拭子检测结果持续呈阴性，患者于3月10日建立术中中央插管静脉-动脉（VA）-ECMO后接受LT。LT后撤除术中VA-ECMO支持。 And the pre-LT VV-ECMO was maintained with low-dose inotropes until Mar 12. The patient was extubated on Apr 2.
Although the pathological findings of coronavirus disease 2019 (COVID-19) associated with acute respiratory distress syndrome (ARDS) have been reported in previous studies, the data of histopathological features of end-stage COVID-19 lungs are still lacking. We have previously reported the clinical features and managements of three COVID-19 patients with irreversible deterioration of pulmonary function who received lung transplantation (LT) after being supported by extracorporeal membrane oxygenation (ECMO)[1]. The detailed history and treatment of the patient has been reported previously [1]. In brief, the male patient was 73years of age with history of type 2 diabetes mellitus, diabetic nephropathy, chronic renal failure, coronary atherosclerotic heart disease, atrial fibrillation, chronic bronchitis, emphysema and deafness. He was admitted to the hospital with the initial symptoms of fever and coughs and was diagnosed as COVID-19 by reverse real-time PCR assay on Feb 2, 2020. The patient gradually developed ARDS during hospitalization and received tracheostomies and invasive mechanical ventilation (MV) on Feb 20. Veno-venous (VV)-ECMO was established on Feb 21. Continuous renal replacement therapy (CRRT) started on Feb 26 due to the rapid increase of serum creatine. Echocardiography (Mar 9) revealed right ventricular failure, biatrial enlargement (left atrium diameter, LAD 43mm), mild mitral insufficiency, mild aortic insufficiency, moderate tricuspid insufficiency, reduced left ventricular diastolic function (mitral valve orifice E peak< A peak), and elevated pulmonary artery pressure (tricuspid annular plane systolic excursion, TAPSE 12mm; flow velocity integral of E wave, TVIE peak< A peak; pulmonary artery systolic pressure, PASP 53 mmHg; ejection fraction, EF 56.01%). Given that the results of throat swab tests of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) had been continuously negative since Feb 25, the patient received LT after establishing intraoperative central cannulated veno-arterial (VA)-ECMO on Mar 10. He was weaned off intraoperative VA-ECMO support after LT. And the pre-LT VV-ECMO was maintained with low-dose inotropes until Mar 12. The patient was extubated on Apr 2.
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影响因子：
6.1
作者：
Chen, Jing-Yu;Qiao, Kun;He, Jian-Xing
通讯作者：
He, Jian-Xing
影响因子：
5.4
作者：
Zhang, Yu;Zhao, Qian;Weng, Yajun
通讯作者：
Weng, Yajun
影响因子：
3.5
作者：
Barton, Lisa M.;Duval, Eric J.;Mukhopadhyay, Sanjay
通讯作者：
Mukhopadhyay, Sanjay
影响因子：
20.4
作者：
Tian, Sufang;Hu, Weidong;Xiao, Shu-Yuan
通讯作者：
Xiao, Shu-Yuan