The evolution of pulmonary pathology in fatal COVID-19 disease: an autopsy study with clinical correlation
The evolution of pulmonary pathology in fatal COVID-19 disease: an autopsy study with clinical correlation
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DOI：
10.1007/s00428-020-02881-x
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发表时间：
2020-06-30
期刊：
影响因子：
3.5
通讯作者：
Fend, Falko
中科院分区：
文献类型：
--
作者：
Boesmueller, Hans;Traxler, Selina;Fend, Falko
2019年冠状病毒病大流行(新冠肺炎)已导致全球超过35.5万人确诊死亡。然而，关于尸检结果的出版物很少。我们报告了四例致命性新冠肺炎的肺部表现，并结合反映病程和病程、侵入性治疗和实验室特征的肺部病理进行了分析。早期疾病的特点是中性粒细胞渗出性毛细管炎伴有微血栓形成，以及高水平的IL-1β和IL-6。晚期与弥漫性肺泡损伤和持续的中小型肺血管内血栓形成有关，偶尔伴有相当于梗死区的区域，并伴有弥漫性血管内凝血的实验室特征。晚期可见机化性肺炎，肺泡内成纤维细胞广泛增殖，肺泡上皮化生明显。病毒RNA存在于肺部，病毒颗粒存在于内皮细胞和肺泡细胞中。在许多患者中，多器官衰竭伴严重的肝损害最终发生，可能是由于早发性促炎细胞因子风暴和/或血栓性微血管病变的结果。
The pandemia of coronavirus disease 2019 (COVID-19) has caused more than 355,000 confirmed deaths worldwide. However, publications on postmortem findings are scarce. We present the pulmonary findings in four cases of fatal COVID-19 with a spectrum of lung pathology reflecting disease course and duration, invasive therapies, and laboratory features. Early disease is characterized by neutrophilic, exudative capillaritis with microthrombosis and high levels of IL-1beta and IL-6. Later stages are associated with diffuse alveolar damage and ongoing intravascular thrombosis in small to medium-sized pulmonary vessels, occasionally with areas of infarction equivalents, accompanied by laboratory features of disseminated intravascular coagulation. In late stages, organizing pneumonia with extensive intra-alveolar proliferation of fibroblasts and marked metaplasia of alveolar epithelium can be observed. Viral RNA is encountered in the lung, with virus particles in endothelial cells and pneumocytes. In many patients, multi-organ failure with severe liver damage sets in finally, possibly as consequence of an early-onset pro-inflammatory cytokine storm and/or thrombotic microangiopathy.