Wu J H, Li X, Huang B, Su H, Li Y, Luo D J, Chen S, Ma L, Wang S H, Nie X, Peng L
Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
Zhonghua Bing Li Xue Za Zhi. 2020 Jun 8;49(6):568-575. doi: 10.3760/cma.j.cn112151-20200405-00291.
To observe the pulmonary changes with coronavirus disease 2019 (COVID-19) in postmortem needle specimens, to detect the presence of 2019 novel coronavirus(2019-nCoV) in the lung tissues, and to analyze the clinicopathological characteristics. For 10 decedents with 2019-nCoV infection in Wuhan, bilateral lungs underwent ultrasound-guided percutaneous multi-point puncture autopsy, and pulmonary pathological changes were described in routine hematoxylin-eosin staining (HE) slides. Electron microscopy was also performed. The reverse transcription polymerase chain reaction (RT-PCR) was employed to detect 2019-nCoV nucleic acid in lung tissue, and the pathological characteristics were demonstrated in combination with clinical data analysis. Of the 10 deaths associated with COVID-19, 7 were male and 3 were female. The average age was 70 (39-87) years. Medical record showed that 7 patients had underlying diseases. The average course of disease was 30 (16-36) days. Nine cases showed fibrinous and suppurative exudation in the alveolar cavity accompanied by the formation of hyaline membrane, and fibroblastic proliferation of alveolar septum. Type Ⅱ alveolar epithelial cells showed reactive hyperplasia and desquamation. Many macrophages accumulated in the alveolar cavity. Capillary hyaline thrombus and intravascular mixed thrombus were noted. In some cases, acute bronchiolitis with mucous membrane exfoliation, accumulation of bronchiolar secretions, and bronchiolar epithelial metaplasia occurred. In the cohort, a large number of bacteria (cocci) were detected in 1 case and a large number of fungi (yeast type) were detected in 1 case. Nine cases were positive for the nucleic acids of 2019-nCoV while one case remained negative by RT-PCR. Coronavirus particles were detected in the cytoplasm of type Ⅱ alveolar epithelium. The pulmonary pathological changes of fatal COVID-19 are diffuse alveolar damage (DAD), mainly in the acute exudative stage and the organic proliferative stage. There are fibrinous exudate aggregation in alveolar cavity with hyaline membrane formation, fibroblastic proliferation in alveolar septum, and alveolar epithelial cell injuries with reactive hyperplasia and desquamation of type Ⅱ alveolar epithelial cells. A large amount of neutrophils and monocytes infiltration is present in most cases and bacteria and fungi are detected in some cases, suggesting a serious bacterial or fungal infection secondary to the DAD.
观察2019冠状病毒病（COVID-19）尸检针吸标本中的肺部变化，检测肺组织中2019新型冠状病毒（2019-nCoV）的存在，并分析临床病理特征。对武汉10例2019-nCoV感染死亡病例的双侧肺进行超声引导下经皮多点穿刺尸检，在苏木精-伊红（HE）常规染色切片中描述肺部病理变化。同时进行电子显微镜检查。采用逆转录聚合酶链反应（RT-PCR）检测肺组织中的2019-nCoV核酸，并结合临床数据分析展示病理特征。在10例与COVID-19相关的死亡病例中，男性7例，女性3例。平均年龄为70（39-87）岁。病历显示7例患者有基础疾病。平均病程为30（16-36）天。9例显示肺泡腔内有纤维素性和化脓性渗出，伴有透明膜形成，肺泡间隔成纤维细胞增生。Ⅱ型肺泡上皮细胞呈反应性增生和脱落。肺泡腔内积聚大量巨噬细胞。可见毛细血管透明血栓和血管内混合血栓。部分病例出现急性细支气管炎，伴有黏膜脱落、细支气管分泌物积聚和细支气管上皮化生。该队列中，1例检测到大量细菌（球菌），1例检测到大量真菌（酵母型）。9例2019-nCoV核酸检测呈阳性，1例RT-PCR检测为阴性。在Ⅱ型肺泡上皮细胞质中检测到冠状病毒颗粒。致命性COVID-19的肺部病理变化为弥漫性肺泡损伤（DAD），主要处于急性渗出期和机化增殖期。肺泡腔内有纤维素渗出物聚集并形成透明膜，肺泡间隔成纤维细胞增生，肺泡上皮细胞损伤，Ⅱ型肺泡上皮细胞反应性增生和脱落。多数病例有大量中性粒细胞和单核细胞浸润，部分病例检测到细菌和真菌，提示DAD继发严重的细菌或真菌感染。
