PDF(Pubmed)
Abstract：
OBJECTIVE: Comparative clinical and morphological characterization of lesions of the vascular and nervous system in cases of maternal death associated with COVID-19.
METHODS: The study included autopsy in 12 cases of maternal death with a positive intravital result for SARS-CoV-2 by reverse transcription polymerase chain reaction. For histopathology, tissue samples were taken from the internal organs of each patient. Pieces of organs were fixed and stained according to the standard protocol. The relative number of microvessels with vasculitis and fibers of the peripheral nervous system with infiltration by immune cells was studied. All morphological changes were classified depending on the severity of the damage.
RESULTS: The average age of patients with a fatal outcome was 35 ± 4.4 years. Time to death after onset of symptoms averaged 16 ± 4.4 days. Dystrophic lesions (necrosis and apoptosis) of the villous and extravillous trophoblast and decidual tissue were observed in the studied placentas. Histopathological signs of mild and severe lesions of the peripheral nervous system in the organs of the gastrointestinal tract were detected in 2 (16.7%) and 10 (83.3%) cases, respectively, in the myocardium in 4 (33.3%) and 8 (66.7%) cases. Histopathological signs of severe damage to the microvascular bed in the organs of the gastrointestinal tract were registered in 9 (75%) cases.
CONCLUSIONS: The main clinical feature of this cohort was that death occurred in a long-term period, in most cases with a negative PCR. The histopathological pattern was a non-acute injury with an immune component of the microvascular bed and the autonomic nervous system with predominant damage to the myocardium and intestines.
UNASSIGNED: This study makes it possible to even better study the immunopathological profile in organs and tissues in pregnant women with a fatal outcome when affected by a viral infection, in particular Covid-19. This knowledge can be used when humanity encounters other viral pandemics in the future.
METHODS: The study included autopsy in 12 cases of maternal death with a positive intravital result for SARS-CoV-2 by reverse transcription polymerase chain reaction. For histopathology, tissue samples were taken from the internal organs of each patient. Pieces of organs were fixed and stained according to the standard protocol. The relative number of microvessels with vasculitis and fibers of the peripheral nervous system with infiltration by immune cells was studied. All morphological changes were classified depending on the severity of the damage.
RESULTS: The average age of patients with a fatal outcome was 35 ± 4.4 years. Time to death after onset of symptoms averaged 16 ± 4.4 days. Dystrophic lesions (necrosis and apoptosis) of the villous and extravillous trophoblast and decidual tissue were observed in the studied placentas. Histopathological signs of mild and severe lesions of the peripheral nervous system in the organs of the gastrointestinal tract were detected in 2 (16.7%) and 10 (83.3%) cases, respectively, in the myocardium in 4 (33.3%) and 8 (66.7%) cases. Histopathological signs of severe damage to the microvascular bed in the organs of the gastrointestinal tract were registered in 9 (75%) cases.
CONCLUSIONS: The main clinical feature of this cohort was that death occurred in a long-term period, in most cases with a negative PCR. The histopathological pattern was a non-acute injury with an immune component of the microvascular bed and the autonomic nervous system with predominant damage to the myocardium and intestines.
UNASSIGNED: This study makes it possible to even better study the immunopathological profile in organs and tissues in pregnant women with a fatal outcome when affected by a viral infection, in particular Covid-19. This knowledge can be used when humanity encounters other viral pandemics in the future.
摘要：
目的：比较与COVID-19相关的孕产妇死亡病例的血管和神经系统病变的临床和形态学特征。
方法：本研究包括通过逆转录聚合酶链反应对12例产妇死亡进行尸检，SARS-CoV-2阳性结果。对于组织病理学，从每个患者的内部器官中采集组织样本。将器官片固定并根据标准方案染色。研究了具有血管炎的微血管和周围神经系统有免疫细胞浸润的纤维的相对数量。根据损伤的严重程度对所有形态变化进行分类。
结果：患者的平均年龄为35±4.4岁。症状发作后至死亡的时间平均为16±4.4天。在研究的胎盘中观察到绒毛和绒毛外滋养层和蜕膜组织的营养不良性病变（坏死和凋亡）。在2例(16.7%)和10例(83.3%)中检出胃肠道器官周围神经系统轻度和重度病变的组织病理学征象,分别,在心肌中4例（33.3％）和8例（66.7％）。在9例（75％）病例中记录了胃肠道器官中微血管床严重受损的组织病理学迹象。
结论：该队列的主要临床特征是长期死亡，在大多数情况下，PCR阴性。组织病理学模式是非急性损伤，具有微血管床和自主神经系统的免疫成分，主要损害心肌和肠道。
这项研究可以更好地研究孕妇的器官和组织中的免疫病理学特征，当受到病毒感染时，会有致命的后果。特别是Covid-19。当人类将来遇到其他病毒大流行时，可以使用这些知识。
方法：本研究包括通过逆转录聚合酶链反应对12例产妇死亡进行尸检，SARS-CoV-2阳性结果。对于组织病理学，从每个患者的内部器官中采集组织样本。将器官片固定并根据标准方案染色。研究了具有血管炎的微血管和周围神经系统有免疫细胞浸润的纤维的相对数量。根据损伤的严重程度对所有形态变化进行分类。
结果：患者的平均年龄为35±4.4岁。症状发作后至死亡的时间平均为16±4.4天。在研究的胎盘中观察到绒毛和绒毛外滋养层和蜕膜组织的营养不良性病变（坏死和凋亡）。在2例(16.7%)和10例(83.3%)中检出胃肠道器官周围神经系统轻度和重度病变的组织病理学征象,分别,在心肌中4例（33.3％）和8例（66.7％）。在9例（75％）病例中记录了胃肠道器官中微血管床严重受损的组织病理学迹象。
结论：该队列的主要临床特征是长期死亡，在大多数情况下，PCR阴性。组织病理学模式是非急性损伤，具有微血管床和自主神经系统的免疫成分，主要损害心肌和肠道。
这项研究可以更好地研究孕妇的器官和组织中的免疫病理学特征，当受到病毒感染时，会有致命的后果。特别是Covid-19。当人类将来遇到其他病毒大流行时，可以使用这些知识。
