Pulmonary Vascular Endothelialitis, Thrombosis, and Angiogenesis in Covid-19
Pulmonary Vascular Endothelialitis, Thrombosis, and Angiogenesis in Covid-19
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DOI：
10.1056/nejmoa2015432
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发表时间：
2020-07-09
影响因子：
158.5
通讯作者：
Jonigk, Danny
中科院分区：
文献类型：
--
作者：
Ackermann, Maximilian;Verleden, Stijn E.;Jonigk, Danny
背景进行性呼吸衰竭是2019冠状病毒病（Covid-19）大流行的主要死亡原因。尽管对该疾病的病理生理学有广泛的兴趣，对于死于Covid-19的患者外周肺的相关形态学和分子变化知之甚少。方法我们检查了死于Covid-19的患者尸检期间获得的7个肺，并将其与死于甲型流感继发急性呼吸窘迫综合征（ARDS）的患者尸检期间获得的7个肺进行比较（H1N1）感染和10个年龄匹配的未感染对照肺。使用七色免疫组织化学分析、显微计算机断层成像、扫描电子显微镜、腐蚀铸型和基因表达的直接多重测量对肺进行了研究。结果在死于Covid-19相关或流感相关呼吸衰竭的患者中，外周肺的组织学模式为弥漫性肺泡损伤伴血管周围T细胞浸润。新冠肺炎患者的肺部也显示出独特的血管特征，包括与细胞内病毒和细胞膜破裂相关的严重内皮损伤。新冠肺炎患者肺血管的组织学分析显示，广泛血栓形成伴微血管病变。新冠肺炎患者肺泡毛细血管微血栓的患病率是流感患者的9倍（P
BackgroundProgressive 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.MethodsWe 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.ResultsIn 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