COVID-19に関連した非閉塞性フィブリン微小血栓
Melanie C Bois1, Nicholas A Boire1, Andrew J Layman1
1Department of Laboratory Medicine and Pathology (M.C.B., N.A.B., A.J.L., M.-C.A., M.P.A., A.C.R., C.E.H., R.A.Q., R.M., B.R.K., P.T.L., J.J.M.), Mayo Clinic, Rochester, MN.
Circulation
|November 16, 2020
まとめ
この研究では,SARS-CoV-2による直接的な心臓感染症は発見されなかったが,COVID-19患者における一般的な心筋線維微血栓は明らかになった. 筋膜炎は一部の症例に存在し,心臓のアミロイドーシスは重度のCOVID-19のアウトカムを悪化させる可能性があります.
科学分野:
- 心臓病科
- ウイルス学
- 病理学について
背景:
- 深刻な急性呼吸器症候群の新型コロナウイルス2型 (SARS-CoV-2型) は,頻繁な心臓合併症による世界的な健康上の脅威であるCOVID-19を引き起こす.
- COVID-19に関連する心臓疾患の正確なメカニズムはほとんど不明です.
- 死亡後の心臓の評価は,SARS-CoV-2感染の病理を理解するために重要である.
研究 の 目的:
- COVID-19患者における心筋病理スペクトルの詳細を明らかにする.
- COVID-19における心臓の発見を他のウイルス性疾患と比較する.
- 心臓におけるアンジオテンシン変換酵素2 (ACE2) の発現を調査し,治癒した感染症例における心臓の発見を記述する.
主な方法:
- COVID-19 (n=15),インフルエンザ (n=6),および対照 (n=6) 症例の死後の心臓評価.
- 生体病理学的分析,ACE2の免疫組織化学,超構造的検査,ウイルス検出のためのRT-PCR.
- 異なる疾患グループと臨床状態 (活性 vs 治癒した感染) における結果の比較
主要な成果:
- 非特異的なフィブリンマイクロトロンビは,活発なCOVID-19症例において一般的であった (P=0.006).
- 焦点性心筋炎は,通常限られた範囲で,活発な (33.3%) およびクリアされたCOVID-19症例で観察されました.
- 低動脈ACE2内皮発現はCOVID-19症例 (P=0. 004) で観察されたが,心筋ACE2発現は異なっていなかった.
- 心臓アミロイドーシスはCOVID-19患者の26.7%で確認された.
結論:
- SARS-CoV-2 の直接的な心筋感染症は,決定的に特定されなかった.
- 心筋線維微血栓はCOVID-19で頻繁に見られるが,普遍的に不血性損傷と関連しているわけではない.
- COVID-19患者のサブセットで発現する心筋炎は,治癒した感染では表情が変動する.
- 心臓のアミロイドーシスは,重症なCOVID-19疾患の追加的な危険因子である可能性があります.
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