ワシントン州における致命的なCOVID-19感染の組織病理学および超構造的発見:症例シリーズ
Benjamin T Bradley1, Heather Maioli2, Robert Johnston3
1Department of Pathology, University of Washington, Seattle, WA, USA; Department of Laboratory Medicine, University of Washington, Seattle, WA, USA.
Lancet (London, England)
|July 20, 2020
まとめ
この研究は,致命的なCOVID-19症例における組織病理学を調査し,肺の主要な病理学として拡散性肺膜損傷を発見した. SARS-CoV-2は複数の臓器で検出され,重症な疾患においてその組織トロピズムを強調した.
科学分野:
- 病理学について
- 感染症
- 肺科
背景:
- 重症急性呼吸器症候群コロナウイルス2型 (SARS-CoV-2型) は,著しい死亡率を伴う世界的なパンデミックを引き起こす.
- 致死したCOVID-19患者の組織病理学的データは,解剖や臓器採取の課題のために限られている.
- この研究は,重度のCOVID-19死亡者における組織病理学的変化とSARS-CoV-2組織トロピズムを記録することを目的とした.
研究 の 目的:
- 重度のCOVID-19症例に関する包括的な臨床病理学的報告を提供すること.
- 死んだCOVID-19患者の組織病理学的発見を特定し,特徴づけること.
- 様々な組織内のSARS-CoV-2の存在と分布を調査する.
主な方法:
- 確認されたSARS-CoV-2感染でCOVID-19で死亡した14人の症例シリーズ.
- 死後の検査は 陰圧隔離室で行いました
- 光顕微鏡検査,免疫ヒスト化学検査,電子顕微鏡検査,RT-PCRを用いた生体病理学的分析.
主要な成果:
- 主な肺の発見は,急性または組織化段階での拡散性肺膜損傷でした.
- SARS-CoV-2のウイルス粒子は呼吸器,腎臓,胃腸組織で検出されました.
- リンパ球性心筋炎は,心臓組織で検出可能なウイルスRNAを持つ1人の患者で観察されました.
結論:
- 拡散性アルベオラ損傷は,肺細胞と気管上皮質にウイルスの存在による重度のCOVID-19の主な病理である.
- 非肺臓器はSARS-CoV-2感染に対する感受性を示したが,病原性におけるその役割についてはさらなる調査が必要である.
- このコホートでは微小血栓症と内皮炎が顕著ではなかった.
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