Institute of Pathology, University Hospital Heidelberg; Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg; Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), University Hospital Heidelberg; Department of Gastroenterology and Hepatology, University Hospital Heidelberg; Institute of Pathology, Hannover Medical School; Biomedical Research in Endstage and Obstructive Lung Dis ease Hannover (BREATH), Center for Lung Research (DZL), Hannover Medical School; TI Biobank; German Center for Infection Research (DZIF), - University Hospital Heidelberg.
Dtsch Arztebl Int. 2020 Jul 20;117(29-30):500-506. doi: 10.3238/arztebl.2020.0500.
The histomorphological changes of lung damage in severe coronavirus disease 2019 (COVID-19) have not yet been adequately characterized. In this article, we describe the sequence of pathological changes in COVID-19 and discuss the implications for approaches to treatment.
Standardized autopsies were performed on thirteen patients who had died of COVID-19. The findings were analyzed together with clinical data from the patients' medical records.
Most (77%) of the deceased patients were men. Their median age at death was 78 years (range, 41-90). Most of them had major pre-existing chronic diseases, most commonly arterial hypertension. The autopsies revealed characteristic COVID-19-induced pathological changes in the lungs, which were regarded as the cause of death in most patients. The main histological finding was sequential alveolar damage, apparently due in large measure to focal capillary microthrombus formation. Alveolar damage leads to the death of the patient either directly or by the induction of pulmonary parenchymal fibrosis. Diffuse lung damage was seen exclusively in invasively ventilated patients.
Autopsies are crucial for the systematic assessment of new diseases such as COVID-19: they provide a basis for further investigations of disease mechanisms and for the devising of potentially effective modes of treatment. The autopsy findings suggest that focal damage of the microvascular pulmonary circulation is a main mechanism of lethal lung disease due to the SARS-CoV-2 virus. It may also be a cause of persistent lung damage in patients who recover from severe COVID-19.
严重 2019 年冠状病毒病（COVID-19）的肺部损伤的组织形态学变化尚未得到充分描述。在本文中，我们描述了 COVID-19 的病理变化序列，并讨论了对治疗方法的影响。
对 13 名因 COVID-19 死亡的患者进行了标准化尸检。将这些发现与患者病历中的临床数据进行了分析。
大多数（77%）死者为男性。他们的死亡时中位年龄为 78 岁（范围为 41-90 岁）。他们大多数人都有主要的先前存在的慢性疾病，最常见的是动脉高血压。尸检显示出特征性的 COVID-19 引起的肺部病理变化，这些变化被认为是大多数患者的死亡原因。主要的组织学发现是连续的肺泡损伤，显然在很大程度上是由于局灶性毛细血管微血栓形成所致。肺泡损伤直接导致患者死亡，或通过诱导肺实质纤维化导致患者死亡。弥漫性肺损伤仅见于接受有创通气的患者中。
尸检对于系统评估 COVID-19 等新发疾病至关重要：它们为进一步研究疾病机制和制定潜在有效的治疗模式提供了依据。尸检结果表明，肺微血管循环的局灶性损伤是 SARS-CoV-2 病毒引起致死性肺部疾病的主要机制。它也可能是从严重 COVID-19 中康复的患者持续肺部损伤的原因。
