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Findings of Hepatic Severe Acute Respiratory Syndrome Coronavirus-2 Infection
Cellular and Molecular Gastroenterology and Hepatology ( IF 7.2 ) Pub Date : 2020-09-28 , DOI: 10.1016/j.jcmgh.2020.09.015
M. Isabel Fiel , Siraj M. El Jamal , Alberto Paniz-Mondolfi , Ronald E. Gordon , Jason Reidy , Jela Bandovic , Rashmi Advani , Saikiran Kilaru , Kamron Pourmand , Stephen Ward , Swan N. Thung , Thomas Schiano

Background & Aims

Liver injury due to coronavirus disease 2019 (COVID-19) is being increasingly recognized. Abnormal liver chemistry tests of varying severities occur in a majority of patients. However, there is a dearth of accompanying liver histologic studies in these patients.

Methods

The current report details the clinical courses of 2 patients having severe COVID-19 hepatitis. Liver biopsies were analyzed under light microscopy, portions of liver tissue were hybridized with a target probe to the severe acute respiratory syndrome coronavirus-2 S gene, and small sections from formalin-fixed paraffin-embedded liver tissue were processed for electron microscopy.

Results

The liver histology of both cases showed a mixed inflammatory infiltrate with prominent bile duct damage, endotheliitis, and many apoptotic bodies. In situ hybridization and electron microscopy suggest the intrahepatic presence of severe acute respiratory syndrome coronavirus-2, the findings of which may indicate the possibility of direct cell injury.

Conclusions

On the basis of the abundant apoptosis and severe cholangiocyte injury, these histopathologic changes suggest a direct cytopathic injury. Furthermore, some of the histopathologic changes may resemble acute cellular rejection occurring after liver transplantation. These 2 cases demonstrate that severe COVID-19 hepatitis can occur even in the absence of significant involvement of other organs.



中文翻译:

肝重症急性呼吸综合征冠状病毒2感染的发现。

背景与目标

由于冠状病毒疾病2019(COVID-19)而引起的肝损伤越来越多地得到认可。大多数患者发生不同严重程度的异常肝化学检查。但是,这些患者缺乏伴随的肝组织学研究。

方法

本报告详细介绍了2例严重COVID-19肝炎患者的临床病程。在光学显微镜下分析肝活检,将肝组织的一部分与目标探针杂交至严重急性呼吸系统综合症冠状病毒2 S基因,并用福尔马林固定石蜡包埋的肝组织的一小部分进行电子显微镜处理。

结果

两种病例的肝组织学检查均显示混合性炎性浸润,伴有明显的胆管损伤,内皮炎和许多凋亡小体。原位杂交和电子显微镜显示严重急性呼吸系统综合症冠状病毒2存在于肝内,其发现可能表明直接细胞损伤的可能性。

结论

基于大量的凋亡和严重的胆管细胞损伤,这些组织病理学改变提示直接的细胞病变。此外,一些组织病理学变化可能类似于肝移植后发生的急性细胞排斥反应。这两个案例表明,即使没有其他器官的大量介入,也可能发生严重的COVID-19肝炎。

更新日期:2020-09-28
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