School of Medicine, Federal University of Cariri, Universidade Federal do Cariri (UFCA), Barbalha, Ceará, Brazil.
Adv Exp Med Biol. 2021;1353:217-224. doi: 10.1007/978-3-030-85113-2_12.
The objective of this systematic review was to analyze the main morphofunctional changes in the involvement of multiple organs in patients infected with SARS-CoV-2, correlating anatomopathological findings with the clinical picture.
The present study selected articles through electronic search of indexed journals in the PubMed and SciVerse Scopus databases, from December 2019 to May 2020, using the keywords "autopsy," "pathogenicity," and "COVID-19." Two hundred nine articles were identified, and the full texts of 18 articles were reviewed, 5 of them being selected for this review.
The ACE2 receptor plays a role in introducing viral material into the cell, having high expression in type II alveoli. Histopathological analyzes of the lungs of patients with COVID-19 show that SARS-CoV-2 produces, in this organ, in addition to an inflammatory process, a diffuse alveolar damage (DAD), which can cause acute respiratory distress syndrome (ARDS). Macroscopically, the lungs become heavier, firmer, and redder. The clinical features of these patients are variable; the most common are respiratory symptoms associated with fever, myalgia, or fatigue.
The observations points to the consensus that the lungs are the main targets of COVID-19, with morphological and functional changes of interest, including important sequels, and presenting diffuse alveolar damage as a substrate for an unfavorable outcome with ARDS. Changes in micro and macroscopic levels corroborate to the clinical progression of the disease and that these alterations are not specific, which ratify, in addition to the anatomopathological examination, a need to use the association of clinical and epidemiological data for diagnostic confirmation.
本系统评价旨在分析 SARS-CoV-2 感染患者多器官受累的主要形态功能变化，将解剖病理学发现与临床表现相关联。
本研究通过电子检索 PubMed 和 SciVerse Scopus 数据库中索引期刊的文章，使用“尸检”、“发病机制”和“COVID-19”等关键词，检索时间为 2019 年 12 月至 2020 年 5 月，共检索到 209 篇文章，对其中 18 篇文章的全文进行了回顾，其中 5 篇被纳入本综述。
ACE2 受体在将病毒物质引入细胞中起作用，在 II 型肺泡中高表达。COVID-19 患者肺的组织病理学分析表明，SARS-CoV-2 在该器官中产生的除了炎症过程外，还有弥漫性肺泡损伤（DAD），这可能导致急性呼吸窘迫综合征（ARDS）。肉眼观察，肺变得更重、更硬、更红。这些患者的临床特征多种多样，最常见的是与发热、肌痛或疲劳相关的呼吸道症状。
这些观察结果表明，肺部是 COVID-19 的主要靶器官，具有形态和功能变化，包括重要的后遗症，并呈现弥漫性肺泡损伤作为 ARDS 不良结局的基础。微观和宏观水平的变化与疾病的临床进展相符，这些改变并不具有特异性，除了解剖病理学检查外，还需要结合临床和流行病学数据进行诊断确认。
