危重型新型冠状病毒肺炎两例的肺组织病理形态学特征

Morphological characteristics of lung tissue in two cases with critical corona virus disease 2019

目的观察危重型新型冠状病毒肺炎患者的肺部病理形态特征,分析临床和病理之间的联系。方法对2020年2月13日和14日首都医科大学附属北京佑安医院死亡的2例危重型新型冠状病毒肺炎患者进行双侧肺穿刺检查,所获肺组织采用常规方法进行脱水、石蜡包埋、切片、苏木精-伊红染色,而后在光学显微镜下进行观察。结果2例危重型新型冠状病毒肺炎患者的肺部形态呈弥漫性肺泡损伤改变。病例1为合并基础疾病的老年患者,病变以渗出、透明膜形成为主,表现为弥漫性肺泡损伤早期改变。病例2为无基础疾病的患者,病变以弥漫炎症细胞浸润,肺泡壁广泛纤维化,肺泡腔内坏死性炎性纤维素性渗出物填塞,肺泡广泛破坏,肺实质化为主,表现为弥漫性肺泡损伤机化期合并细菌性肺炎。两例患者支气管旁黏膜下腺体损伤均不明显。结论弥漫性肺泡损伤是危重型新型冠状病毒肺炎的主要病理学特征。弥漫性肺泡损伤早期即可诱发或加重老年患者的原有基础疾病。弥漫性肺泡损伤晚期,肺泡广泛破坏、肺实质化和继发感染是导致患者呼吸衰竭的主要原因。

Objective To observe the morphological characteristics of lungs in patients with critical corona virus disease 2019(COVID-19),and to analyze the clinical-pathological relationship.Methods Two critical patients with COVID-19 who died in Beijing You′an Hospital,Capital Medical University on February 13 and 14,2020,respectively,were examined by bilateral lungs biopsy.The obtained samples were dehydrated,paraffin embedded,sectioned,stained with hematoxylin-eosin as routine methods,and then observed under light microscope.Results The pulmonary morphology changes of patients with COVID-19 showed diffuse alveolar damage.Case one was an elderly patient with underlying diseases and her lesions were mainly exudation and hyaline membrane formation,which showed an acute exudation stage of diffuse alveolar damage.Case two was a patient without underlying diseases and his pathological changes were diffuse inflammatory cell infiltration,extensive fibrosis of alveolar wall,filling of necrotizing inflammatory cellulosic exudate in alveolar airspace,extensive destruction of alveoli and pulmonary consolidation,which was characterized by organized stage of diffuse alveolar damage complicated with bacterial pneumonia.The injury of paracronchial submucosal gland was not observed in the two patients.Conclusions Diffused alveolar damage is the main pathological feature of critical COVID-19.Diffused alveolar damage can induce or aggravate the underlying diseases of elderly patients in the early stage.Extensive destruction of alveoli,pulmonary consolidation and secondary infection are the main causes of respiratory failure in the late stage.