PDF(Pubmed)
Abstract：
While considerable attention has been devoted to respiratory manifestations, such as pneumonia and acute respiratory distress syndrome (ARDS), emerging evidence underlines the significance of extrapulmonary involvement. In this study, we examined 15 hospitalized patients who succumbed to severe complications following SARS-CoV-2 infection. These patients were admitted to the Sibiu County Clinical Emergency Hospital in Sibiu, Romania, between March and October 2021. All patients were ethnic Romanians. Conducted within a COVID-19-restricted environment and adhering to national safety protocols, autopsies provided a comprehensive understanding of the disease\'s multisystemic impact. Detailed macroscopic evaluations and histopathological analyses of myocardial, renal, hepatic, splenic, and gastrointestinal tissues were performed. Additionally, reverse transcription-quantitative polymerase chain reaction (rt-qPCR) assays and immunohistochemical staining were employed to detect the viral genome and nucleocapsid within the tissues. Myocardial lesions, including ischemic microstructural changes and inflammatory infiltrates, were prevalent, indicative of COVID-19\'s cardiac implications, while renal pathology revealed the chronic alterations, acute tubular necrosis, and inflammatory infiltrates most evident. Hepatic examination identified hepatocellular necroinflammatory changes and hepatocytic cytopathy, highlighting the hepatic involvement of SARS-CoV-2 infection. Splenic parenchymal disorganization was prominent, indicating systemic immune dysregulation. Furthermore, gastrointestinal examinations unveiled nonspecific changes. Molecular analyses detected viral genes in various organs, with immunohistochemical assays confirming viral presence predominantly in macrophages and fibroblasts. These findings highlighted the systemic nature of SARS-CoV-2 infection, emphasizing the need for comprehensive clinical management strategies and targeted therapeutic approaches beyond respiratory systems.
摘要：
虽然人们对呼吸表现给予了相当多的关注，如肺炎和急性呼吸窘迫综合征（ARDS），新出现的证据强调了肺外参与的重要性.在这项研究中,我们检查了15例SARS-CoV-2感染后死于严重并发症的住院患者。这些患者被送往锡比乌市锡比乌县临床急诊医院,罗马尼亚,2021年3月至10月。所有患者都是罗马尼亚人。在COVID-19受限环境中进行，并遵守国家安全协议，尸检提供了对疾病的多系统影响的全面了解。详细的宏观评估和心肌组织病理学分析，肾,肝，脾,和胃肠道组织进行。此外,采用逆转录-定量聚合酶链反应(rt-qPCR)和免疫组织化学染色检测组织内的病毒基因组和核衣壳.心肌损伤,包括缺血性微结构改变和炎症浸润，普遍存在，表明COVID-19的心脏影响，虽然肾脏病理学显示了慢性改变，急性肾小管坏死,炎症浸润最明显。肝脏检查发现肝细胞坏死性炎症变化和肝细胞病变，强调SARS-CoV-2感染的肝脏受累。脾实质紊乱突出，表明全身免疫失调。此外，胃肠道检查揭示了非特异性变化。分子分析在各种器官中检测到病毒基因，免疫组织化学测定证实病毒主要存在于巨噬细胞和成纤维细胞中。这些发现强调了SARS-CoV-2感染的系统性，强调需要全面的临床管理策略和呼吸系统以外的有针对性的治疗方法。
