COVID-19 尸检中罕见心肌炎:277 例尸检的心血管发现。
Myocarditis is rare in COVID-19 autopsies: cardiovascular findings across 277 postmortem examinations.
机构信息
Department of Pathology, Johns Hopkins University, School of Medicine, Baltimore, MD.
Department of Pathology, Louisiana State University Health Sciences Center, New Orleans, LA.
出版信息
Cardiovasc Pathol. 2021 Jan-Feb;50:107300. doi: 10.1016/j.carpath.2020.107300. Epub 2020 Oct 23.
The COVID-19 pandemic, the result of severe acute respiratory syndrome (SARS)-CoV-2, is a major cause of worldwide mortality with a significant cardiovascular component. While a number of different cardiovascular histopathologies have been reported at postmortem examination, their incidence is unknown, due to limited numbers of cases in any given study. A literature review was performed identifying 277 autopsied hearts across 22 separate publications of COVID-19 positive patients. The median age of the autopsy cohort was 75 and 97.6% had one or more comorbidities. Initial review of the data indicate that myocarditis was present in 20 hearts (7.2%); however, closer examination of additional reported information revealed that most cases were likely not functionally significant and the true prevalence of myocarditis is likely much lower (<2%). At least one acute, potentially COVID-19-related cardiovascular histopathologic finding, such as macro or microvascular thrombi, inflammation, or intraluminal megakaryocytes, was reported in 47.8% of cases. Significant differences in reporting of histopathologic findings occurred between studies indicating strong biases in observations and the need for more consistency in reporting. In conclusion, across 277 cases, COVID-19-related cardiac histopathological findings, are common, while myocarditis is rare.
新型冠状病毒病(COVID-19)是由严重急性呼吸系统综合征冠状病毒 2 型(SARS-CoV-2)引起的,是导致全球死亡率的主要原因,具有显著的心血管成分。虽然在尸检检查中已经报告了许多不同的心血管组织病理学变化,但由于在任何给定的研究中,病例数量有限,因此其发生率尚不清楚。进行了文献复习,确定了 22 篇单独的 COVID-19 阳性患者尸检研究中的 277 例尸检心脏。尸检队列的中位年龄为 75 岁,97.6%的患者有一个或多个合并症。对数据的初步审查表明,20 例心脏(7.2%)存在心肌炎;然而,对额外报告信息的更仔细检查表明,大多数病例可能没有明显的功能意义,心肌炎的真实患病率可能低得多(<2%)。至少有 1 例急性、可能与 COVID-19 相关的心血管组织病理学发现,如巨或微血管血栓形成、炎症或管腔内巨核细胞,在 47.8%的病例中报告。研究之间在报告组织病理学发现方面存在显著差异,表明观察存在强烈的偏倚,需要更一致的报告。总之,在 277 例病例中,与 COVID-19 相关的心脏组织病理学发现很常见,而心肌炎很少见。