心脏中的COVID-19相关的非封闭性纤维素微血栓
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
概括
这项研究没有发现直接的SARS-CoV-2心脏感染,但在COVID-19患者中发现了常见的心脏纤维素微血栓. 有些病例存在心肌炎,心肌粉症可能会加重COVID-19的严重后果.
科学领域:
- 心脏病学
- 病毒学
- 病理学
背景情况:
- 严重急性呼吸道综合征冠状病毒2 (SARS-CoV-2) 是导致COVID-19的全球性健康威胁,并经常引起心脏并发症.
- 与COVID-19相关的心脏问题背后的确切机制在很大程度上是未知的.
- 死亡后的心脏评估对于了解SARS-CoV-2感染病理至关重要.
研究的目的:
- 详细介绍COVID-19患者的心肌病态谱.
- 将COVID-19中的心脏发现与其他病毒性疾病进行比较.
- 调查心脏中的血管素转化酶2 (ACE2) 表达,并描述已清除感染病例中的心脏发现.
主要方法:
- 对COVID-19 (n=15),流感 (n=6) 和对照病例的死后心脏评估.
- 组织病理学分析,ACE2的免疫组织化学,超结构检查和RT-PCR用于病毒检测.
- 不同疾病组和临床状态 (活跃感染与清除感染) 的发现比较.
主要成果:
- 在活跃的COVID-19病例中,非特异性纤维素微血栓很常见 (P=0.006).
- 在活跃的 (33.3%) 和已治愈的COVID-19病例中观察到焦点性心肌炎,通常范围有限.
- 在COVID-19病例中观察到较低的动脉内皮ACE2表达 (P=0.004),但心肌ACE2表达没有差异.
- 在26.7%的COVID-19患者中发现心脏粉症.
结论:
- 没有明确确确诊断出直接心肌性SARS-CoV-2感染.
- 心脏纤维素微血栓在COVID-19中很常见,但并不普遍与缺血性损伤有关.
- 肌心炎发生在一小部分COVID-19患者中,在已清除的感染中呈现不同.
- 心脏粉症可能是严重COVID-19疾病的额外危险因素.
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