Hepatic pathology in patients dying of COVID-19: a series of 40 cases including clinical, histologic, and virologic data
Hepatic pathology in patients dying of COVID-19: a series of 40 cases including clinical, histologic, and virologic data
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DOI：
10.1038/s41379-020-00649-x
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发表时间：
2020-08-13
期刊：
影响因子：
7.5
通讯作者：
Verna, Elizabeth C.
中科院分区：
文献类型：
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作者：
Lagana, Stephen M.;Kudose, Satoru;Verna, Elizabeth C.
新型冠状病毒 SARS-CoV-2（冠状病毒病 19，或 COVID-19）主要引起肺损伤，但通过血清标志物和组织学评估，表明可能引起肝损伤。损伤的组织学模式尚未完全描述。缺乏量化肝脏病毒载量的研究。在此，我们报告了 40 名死于 COVID-19 并发症的患者的与肝脏相关的临床和组织学结果。对一部分肝组织块进行聚合酶链式反应 (PCR) 检测病毒核糖核酸 (RNA)。丙氨酸氨基转移酶（ALT）和天冬氨酸氨基转移酶（AST）的峰值水平升高； ALT 峰值中位数 68 U/l（正常高达 46 U/l）和 AST 峰值中位数 102 U/l（正常高达 37 U/l）。大泡性脂肪变性是最常见的发现，涉及 30 名患者 (75%)。轻度小叶坏死性炎症和汇管部炎症各 20 例（50%）。血管病理，包括窦状微血栓，并不常见，仅见于 6 例（15%）。 20 名接受检测的患者中有 11 名 (55%) 的肝组织 PCR 呈阳性。总之，我们发现死于 COVID-19 的患者有肝炎（严重程度不等）的生化证据，并表现出大泡性脂肪变性和轻度急性肝炎（小叶坏死性炎症）和轻度门静脉炎症的组织学表现。我们还在相当大的肝组织样本中鉴定出了病毒 RNA。
The novel coronavirus SARS-CoV-2 (coronavirus disease 19, or COVID-19) primarily causes pulmonary injury, but has been implicated to cause hepatic injury, both by serum markers and histologic evaluation. The histologic pattern of injury has not been completely described. Studies quantifying viral load in the liver are lacking. Here we report the clinical and histologic findings related to the liver in 40 patients who died of complications of COVID-19. A subset of liver tissue blocks were subjected to polymerase chain reaction (PCR) for viral ribonucleic acid (RNA). Peak levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were elevated; median ALT peak 68 U/l (normal up to 46 U/l) and median AST peak 102 U/l (normal up to 37 U/l). Macrovesicular steatosis was the most common finding, involving 30 patients (75%). Mild lobular necroinflammation and portal inflammation were present in 20 cases each (50%). Vascular pathology, including sinusoidal microthrombi, was infrequent, seen in six cases (15%). PCR of liver tissue was positive in 11 of 20 patients tested (55%). In conclusion, we found patients dying of COVID-19 had biochemical evidence of hepatitis (of variable severity) and demonstrated histologic findings of macrovesicular steatosis and mild acute hepatitis (lobular necroinflammation) and mild portal inflammation. We also identified viral RNA in a sizeable subset of liver tissue samples.