移植心脏中的早期,快速进展的血管病变:COVID-19的可能并发症
Bryan G Pearson1, David H Walker2, Alfred S Lea3
1John Sealy School of Medicine, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, USA.
概括
严重急性呼吸系统综合征冠状病毒2 (SARS-CoV-2) 在心脏移植接受者的感染导致了快速的心脏合移植血管病变 (CAV). 尸检显示冠状动脉中的SARS-CoV-2,表明内皮损伤是关键机制.
科学领域:
- 心脏病学 心脏病学
- 移植免疫学 移植免疫学
- 传染性疾病 传染性疾病
背景情况:
- 免疫抑制群体,如心脏移植接受者,容易受到严重急性呼吸系统综合征冠状病毒2 (SARS-CoV-2) 的严重后果.
- 冠状病毒疾病2019 (COVID-19) 可以引发严重的心血管并发症,包括心律不整,心肌损伤和血栓事件.
研究的目的:
- 报告一个独特的病例,心脏移植接受者在感染SARS-CoV-2后发展出快速进展的心脏全移植血管病变 (CAV).
- 调查SARS-CoV-2在移植后血管并发症的发病过程中的潜在作用.
主要方法:
- 一位心脏移植接受者随后感染COVID-19的案例介绍.
- 诊断程序包括内肌心活检和尸检.
- 免疫组织化学 (IHC) 用于在心脏组织中定位SARS-CoV-2核囊蛋白.
主要成果:
- 患者患有急性T细胞介导的异体移植排斥,随后突然死亡.
- 尸体解剖揭示了扩散的上心,血管拥堵和冠状动脉严重的集中狭窄,与快速进展的CAV一致.
- IHC检测到SARS-CoV-2核体蛋白在冠状动脉静脉和毛细血管的内皮细胞内.
结论:
- 这一案例突出显示了SARS-CoV-2感染与心脏移植接受者的加速心脏全移植血管病变之间的潜在联系.
- 内皮细胞感染和随后的内皮炎可能是导致这种快速血管损伤的主要机制.
- 这一病例代表了一种异常早期和激进的CAV形式,得到了全面的尸检和IHC发现的支持.
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