Circulation:微血栓是新冠肺炎患者心脏损伤的主要原因!

2021-03-11 Nebula MedSci原创

新冠肺炎患者常见心脏损失,这类患者预后往往更差;新冠患者的心脏损伤的病因是什么呢?

住院治疗的新冠肺炎COVID-19)患者常见心脏损失,这类患者预后往往更差。但是,与新冠肺炎病毒(SARS-CoV-2)相关的心肌损伤的类型和机制仍未完全明确。

Pellegrini等人对40例意大利Bergamo因新冠肺炎死亡的住院患者的心脏进行了系统性的病理分析,明确了新冠肺炎患者心肌损伤的病理机制,并将研究结果于近期发表在了《循环》“Circulation”期刊上。

在检测的40例心脏中,有14例(35%)证实存在心肌细胞坏死,主要位于左心室。与无坏死的受试者相比,有坏死的受试者更多为女性,患有慢性肾病和入院症状发作更短。有无坏死的患者之间的重度冠状动脉疾病的发生率(如梗阻面积超过75%)无显著差异。

心肌坏死病理

14位存在心肌细胞坏死的受试者中有3位(21.4%)表现出急性心肌梗死的证据,定义为坏死面积≥1 cm2,11位(78.6%)患者表现出局部心肌坏死(坏死心肌细胞>20个,0.05 mm2≤坏死面积<1 cm2)的证据。在这14例有心肌细胞坏死的病例中,有11例(78.6%)存在心脏栓塞,有2例(14.2%)存在心外膜冠状动脉血栓,还有9例(64.3%)存在心肌毛细血管和小动脉微血栓。

不同来源血栓的成分对比

研究人员对比了COVID-19阳性活检病例的心脏微血栓和心肌内血栓以及表现为ST段抬高型心肌梗死的感染和未感染COVID-19的患者经皮冠脉介入治疗时取得的吸入性血栓。与COVID-19阴性个体的心肌内血栓和吸入性血栓相比,COVID-19阳性个体的心脏微血栓具有明显更高的纤维蛋白和末端补体C5b-9免疫染色。ST段抬高型心肌梗死的COVID-19阳性和阴性患者之间的吸入性血栓的成分无明显差异。

综上所述,心肌细胞坏死的最常见病理原因是微血栓。COVID-19患者心脏微血栓的成分与其他类似患者的心肌间血栓和冠脉血栓的成分不同。量身定制的抗血栓策略或有助于预防COVID-19感染造成的心脏损伤。

原始出处:

Dario Pellegrini, et al. Microthrombi as a Major Cause of Cardiac Injury in COVID-19. Circulation. 2021;143:1031–1042

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    2021-03-12 jacob9231

    学习了谢谢

    0

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    2021-03-12 飞翔的乌龟

    0

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    2021-03-12 公卫新人

    新冠肺炎,疫情何时才能消失

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1398104, encodeId=650b139810492, content=<a href='/topic/show?id=8bee565436d' target=_blank style='color:#2F92EE;'>#损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56543, encryptionId=8bee565436d, topicName=损伤)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智慧医人, createdTime=Sat Mar 13 14:23:05 CST 2021, time=2021-03-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1436878, encodeId=828b14368e8d2, content=<a href='/topic/show?id=4290515241f' target=_blank style='color:#2F92EE;'>#心脏损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51524, encryptionId=4290515241f, topicName=心脏损伤)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Sat Mar 13 14:23:05 CST 2021, time=2021-03-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1464276, encodeId=ce0614642e62b, content=<a href='/topic/show?id=bb8050e7336' target=_blank style='color:#2F92EE;'>#微血栓#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50773, encryptionId=bb8050e7336, topicName=微血栓)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=20216649846, createdName=闆锋旦, createdTime=Sat Mar 13 14:23:05 CST 2021, time=2021-03-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=947718, encodeId=688e94e7187d, content=学习了谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM66WRRAmeqIVSnDN88DpaJfEWzRZxg4yBbiaBmMRwcvViaA2C0sE0Ts3Lic24JSSI4YffujDtpnm0GTHpuiao9TytmNArrcYESnSXY/0, createdBy=7938104912, createdName=jacob9231, createdTime=Fri Mar 12 19:22:36 CST 2021, time=2021-03-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=947589, encodeId=86a794e5890a, content=赞, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201110/2d55d24dc5fd419d994b7b920c79731b/d3c8bdca983c4af1b90220a8192e353a.jpg, createdBy=e14e5296465, createdName=飞翔的乌龟, createdTime=Fri Mar 12 09:19:56 CST 2021, time=2021-03-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1029228, encodeId=57671029228e3, content=新冠肺炎,疫情何时才能消失, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=公卫新人, createdTime=Fri Mar 12 02:23:05 CST 2021, time=2021-03-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=947552, encodeId=973d94e55237, content=心肌细胞坏死的常见病理原因是微血栓 , beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210310/466b1701110f4394ae3a6cd607844bd5/1b665134aa2b423c873ad0ca9920f82b.jpg, createdBy=bb545451118, createdName=小孔医生, createdTime=Fri Mar 12 00:37:22 CST 2021, time=2021-03-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=947545, encodeId=b4f194e54556, content=棒, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1a495128539, createdName=1464f029m98暂无昵称, createdTime=Thu Mar 11 23:51:22 CST 2021, time=2021-03-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=947537, encodeId=cb2594e537a0, content=学习了谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM66WRRAmeqIVSnDN88DpaJfEWzRZxg4yBbiaBmMRwcvViaA2C0sE0Ts3Lic24JSSI4YffujDtpnm0GTHpuiao9TytmNArrcYESnSXY/0, createdBy=7938104912, createdName=jacob9231, createdTime=Thu Mar 11 23:31:29 CST 2021, time=2021-03-11, status=1, ipAttribution=)]
    2021-03-12 小孔医生

    心肌细胞坏死的常见病理原因是微血栓

    0

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    2021-03-11 1464f029m98暂无昵称

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    2021-03-11 jacob9231

    学习了谢谢

    0

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提起血栓,大家都很熟悉,而在我们的微血管循环系统中,有一种血栓类并发症,早期不易诊断,各时期实验室检查特点也不同,且病死率高,那就是弥散性血管内凝血。