Patološki nalazi u organima i tkivima pacijenata oboljelih od COVID-19: sistematski pregled.
PloS one
Sažetak istraživanja
Pozadina Koronavirusna bolest (COVID-19) je pandemija uzrokovana SARS-CoV-2 koja je uzrokovala više od 2,2 miliona smrtnih slučajeva širom svijeta. Sažimamo prijavljene patološke nalaze na biopsiji i obdukciji kod pacijenata s teškim/fatalnim COVID-19 i dokumentiramo prisutnost i/ili učinak SARS-CoV-2 u svim organima.
Metode i nalazi Izvršena je sistematska pretraga baza podataka PubMed, Embase, MedRxiv, Lilacs i Epistemonikos od januara do avgusta 2020. za sve izvještaje slučajeva i serije slučajeva koji su prijavili histopatološke nalaze infekcije COVID-19 na obdukciji ili biopsiji tkiva. 603 slučaja COVID-19 iz 75 od 451 pregledane studije ispunila su kriterije za uključivanje. Najčešći patološki nalazi bili su pluća: difuzno alveolarno oštećenje (DAD) (92%) i superponirana akutna bronhopneumonija (27%); jetra: hepatitis (21%), srce: miokarditis (11,4%). Vaskulitis je bio čest samo kod biopsija kože (25%). Mikrotrombi su opisani u placenti (57,9%), plućima (38%), bubrezima (20%), centralnom nervnom sistemu (CNS) (18%) i gastrointestinalnom (GI) traktu (2%). Povreda endotelnih ćelija bila je česta u plućima (18%) i srcu (4%). Hemodinamske promjene poput nekroze zbog hipoksije/hipoperfuzije, edema i kongestije bile su česte u bubrezima (53%), jetri (48%), CNS-u (31%) i GI traktu (18%). Virusne čestice SARS-CoV-2 demonstrirane su u ćelijama specifičnim za organ u traheji, plućima, jetri, debelom crijevu, bubrezima, CNS-u bilo elektronskom mikroskopijom, imunofluorescencijom ili imunohistohemijom. Dodatna tkiva su bila pozitivna samo prema testovima lančane reakcije polimeraze (PCR). Uključene studije su bile iz brojnih zemalja, neke nisu bile recenzirane, a neke su studije izveli subspecijalisti, što je rezultiralo promjenjivim i nedosljednim izvještavanjem ili preteranim iznošenjem prijavljenih nalaza.
Zaključci Glavni patološki nalazi teške/fatalne COVID-19 infekcije su DAD, promjene povezane s koagulopatijom i/ili hemodinamskim poremećajem. Osim toga, prema uočenom oštećenju organa miokarditis može biti povezan s posljedicama.
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Pathological findings in organs and tissues of patients with COVID-19: A systematic review.
Background Coronavirus disease (COVID-19) is the pandemic caused by SARS-CoV-2 that has caused more than 2.2 million deaths worldwide. We summarize the reported pathologic findings on biopsy and autopsy in patients with severe/fatal COVID-19 and documented the presence and/or effect of SARS-CoV-2 in all organs.
Methods and findings A systematic search of the PubMed, Embase, MedRxiv, Lilacs and Epistemonikos databases from January to August 2020 for all case reports and case series that reported histopathologic findings of COVID-19 infection at autopsy or tissue biopsy was performed. 603 COVID-19 cases from 75 of 451 screened studies met inclusion criteria. The most common pathologic findings were lungs: diffuse alveolar damage (DAD) (92%) and superimposed acute bronchopneumonia (27%); liver: hepatitis (21%), heart: myocarditis (11.4%). Vasculitis was common only in skin biopsies (25%). Microthrombi were described in the placenta (57.9%), lung (38%), kidney (20%), Central Nervous System (CNS) (18%), and gastrointestinal (GI) tract (2%). Injury of endothelial cells was common in the lung (18%) and heart (4%). Hemodynamic changes such as necrosis due to hypoxia/hypoperfusion, edema and congestion were common in kidney (53%), liver (48%), CNS (31%) and GI tract (18%). SARS-CoV-2 viral particles were demonstrated within organ-specific cells in the trachea, lung, liver, large intestine, kidney, CNS either by electron microscopy, immunofluorescence, or immunohistochemistry. Additional tissues were positive by Polymerase Chain Reaction (PCR) tests only. The included studies were from numerous countries, some were not peer reviewed, and some studies were performed by subspecialists, resulting in variable and inconsistent reporting or over statement of the reported findings.
Conclusions The main pathologic findings of severe/fatal COVID-19 infection are DAD, changes related to coagulopathy and/or hemodynamic compromise. In addition, according to the observed organ damage myocarditis may be associated with sequelae.
Izvorni podaci
- DOI
- 10.1371/journal.pone.0250708
- PMID
- 33909679
- PMCID
- PMC8081217
- Provjereno
- 2026-07-26
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