Newcastle University Translational and Clinical Research Institute, Newcastle upon Tyne, UK.
Department of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
Lancet Respir Med. 2022 Jan;10(1):95-106. doi: 10.1016/S2213-2600(21)00408-2. Epub 2021 Dec 3.
The lungs are the main site that is affected in severe COVID-19, and post-mortem lung tissue provides crucial insights into the pathophysiology of severe disease. From basic histology to state-of-the-art multiparameter digital pathology technologies, post-mortem lung tissue provides snapshots of tissue architecture, and resident and inflammatory cell phenotypes and composition at the time of death. Contrary to early assumptions that COVID-19 in the lungs is a uniform disease, post-mortem findings have established a high degree of disease heterogeneity. Classic diffuse alveolar damage represents just one phenotype, with disease divisible by early and late progression as well as by pathophysiological process. A distinct lung tissue state occurs with secondary infection; extrapulmonary causes of death might also originate from a pathological process in the lungs linked to microthrombosis. This heterogeneity of COVID-19 lung disease must be recognised in the management of patients and in the development of novel treatment strategies.
肺部是严重 COVID-19 的主要受累器官，尸检肺组织为深入了解严重疾病的病理生理学提供了关键见解。从基础组织学到最先进的多参数数字病理学技术，尸检肺组织提供了死亡时组织结构以及常驻和炎症细胞表型和组成的快照。与 COVID-19 肺部疾病早期的统一假设相反，尸检结果已经确定了高度的疾病异质性。经典弥漫性肺泡损伤仅代表一种表型，疾病可通过早期和晚期进展以及病理生理过程进行划分。继发感染会出现明显的肺组织状态；非肺部死亡原因也可能源于与微血栓形成相关的肺部病理过程。在 COVID-19 肺病的管理和新型治疗策略的开发中，必须认识到这种疾病的异质性。
