Lancet Neurology:德国新冠肺炎患者的神经病理学:尸检病例系列

2020-11-13 MedSci原创 MedSci原创

由严重急性呼吸综合征冠状病毒2型(SARS-CoV-2)引起的疾病COVID-19,自2019年12月首次出现病例以来,目前已演变成全球性大流行。

由严重急性呼吸综合征冠状病毒2型(SARS-CoV-2)引起的疾病COVID-19,自2019年12月首次出现病例以来,目前已演变成全球性大流行。虽然SARS-CoV-2主要针对呼吸道,但其他器官系统如肾脏和血管系统也会受到影响。COVID-19的突出临床症状包括中枢神经系统(CNS)表现,如嗅觉缺失和衰老、非特异性症状(如头晕和头痛)和严重症状(如缺血性中风、出血性脑病和伴有癫痫发作的后部可逆性脑病综合征)。然而,目前尚不清楚SARS-CoV-2作为COVID-19的致病因子是否会进入中枢神经系统,以及它是否会引起神经病理学改变。我们研究了死于COVID-19的患者的脑组织,观察了胶质反应、炎症变化以及CNS中是否存在SARS-CoV-2。

方法:在这个尸检病例系列中,我们调查了德国汉堡2020年3月13日至4月24日期间死亡的患者大脑的神经病理学特征。纳入标准包括通过定量RT-PCR(qRT-PCR)检测SARS-CoV-2阳性并有足够的样本。我们对嗅球、基底节、脑干和小脑中的活化星形胶质细胞、活化小胶质细胞和细胞毒性T淋巴细胞进行了组织学染色和免疫组织化学染色。此外,我们还通过qRT-PCR和免疫组织化学方法研究了SARS-CoV-2在部分患者和脑区的存在和定位。

结果:43名患者被纳入本文研究中。患者死于医院、疗养院或家中,年龄在51岁至94岁之间(中位数为76岁[IQR 70-86])。我们在6名(14%)患者中检测到新的局部缺血病变。37例(86%)患者在所有评估区域均有星形胶质细胞增生。小胶质细胞的激活和细胞毒性T淋巴细胞的浸润在脑干和小脑最为明显,34例(79%)患者可见脑膜细胞毒性T淋巴细胞浸润。在接受检查的40名患者中,有21名(53%)的患者的大脑中可以检测到SARS-CoV-2,其发现于源自下脑干的脑神经和分离的脑干细胞中。中枢神经系统中SARS-CoV-2的存在与神经病理学变化的严重程度无关。

综上所述,我们的研究结果表明SARS-CoV-2 RNA和蛋白质可以在CNS中检测到。大脑表现出轻微的神经病理学改变,脑干明显的神经炎症是最常见的。然而,中枢神经系统中SARS-CoV-2的存在与神经病理改变的严重程度无关。

Matschke, Jakob et al. Neuropathology of patients with COVID-19 in Germany: a post-mortem case series.The Lancet Neurology, Volume 19, Issue 11, 919 - 929

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    2021-03-14 howi
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    2020-12-25 yinhl1978
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    2020-11-14 zhouqu_8
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    2020-11-14 jktdtl
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    2020-11-14 axin012
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    2020-11-12 公卫新人

    新冠肺炎,疫情何时才能消失

    0

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    2020-11-12 goodbing

    顶刊就是不一样,质量很高,内容精彩!学到很多

    0