在COVID-19患者中肝损伤和凝血受损:一个病例系列
Ludovico Abenavoli1, Isabella Aquila2, Matteo Antonio Sacco2
1Department of Health Sciences, University "Magna Græcia", Viale Europa, 88100 Catanzaro, Italy.
Diseases (Basel, Switzerland)
|October 24, 2023
概括
严重的COVID-19会导致与血液凝固问题相关的肝损伤. 患者的高D-二聚体和低纤维素水平表明疾病严重程度和肝损伤,突出显示了凝血平衡的重要性.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 病毒学 病毒学
- 病理学 病理学 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) 流行病对全球医疗保健系统构成了重大挑战.
- 肝损伤在严重的2019年冠状病毒病 (COVID-19) 中的作用尚不清楚,目前还在争论这是否是一种直接的病毒效应,还是系统性炎症的次要因素.
- 严重的COVID-19肝脏参与与较差的临床结果和增加的死亡率相关.
研究的目的:
- 调查严重COVID-19患者肝损伤的特征.
- 在致命的COVID-19病例中探索凝血异常和肝脏病理之间的关系.
- 为了确定COVID-19患者肝病严重程度的潜在预后标志物.
主要方法:
- 对10名死于严重COVID-19的患者死后肝脏检查的分析.
- 实验室参数的评估,包括前热血素时间,部分血栓塑时间,纤维素,抗热血素III和D-二次体.
- 肝脏组织的基因组学评估,以检测肥胖症,炎症,纤维化和纤维状物质.
主要成果:
- 肺血栓塞栓症是50%的病例的主要死亡原因.
- 从入院到死亡时,活性部分血栓形成时间 (aPTT) 和性酸酶 (ALP) 的显著增加以及白蛋白的减少被观察到.
- 死后肝脏组织学揭示了微型和巨型水性肥胖症,肝胆炎,可变纤维化和有组织的纤维质物质.
结论:
- 在严重的COVID-19中,肝病与凝血和纤维溶解通路的失调有关.
- 低纤维素和高D-二聚合物水平,以及特定的组织学发现,表明它们作为肝病严重程度的预后标志物的潜力.
- 保持凝血平衡对于治疗严重COVID-19患者至关重要.
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