(Fighting new crown pneumonia) New discovery under scalpel: How to fight the "defense of the lungs"?

China News Agency, Beijing, March 6th: A new discovery under the scalpel: How to fight the "defense of the lungs"?

Author Zhang Su Li Jingze

From the pathological minimally invasive autopsy report of patients with neocoronary pneumonia, to autopsy reports, to whole lung biopsy pathology reports, many scientific research teams have tried to "cut" the true face of neocoronavirus with the help of a scalpel. What are the implications of these findings for clinical treatment, especially the "defense of the lungs"?

What was found in the pathological report of the whole lung biopsy?

A pathological report of a full lung biopsy of critically ill patients with new coronary pneumonia was published on the Preprints website on the 2nd. The report was completed by the research team of Shenzhen Third People's Hospital and National Infectious Diseases Clinical Medical Research Center. They performed a biopsy of a lung of a critically ill patient with new coronary pneumonia who underwent lung transplantation. This patient is 66 years old, except for 8 years of history of hypertension, no other basic diseases, and good heart function.

The results of the study showed that alveolar edema accompanied with pulmonary damage such as hemorrhage, bronchiolitis, and alveolar inflammation epithelial inflammatory injury. The research team also observed a large number of pulmonary interstitial fibrosis, thickening of the tube wall, luminal stenosis and occlusion. It is speculated that these major changes may lead to severe respiratory failure in critically ill patients. It is particularly noted that hemorrhagic necrosis occurs mainly in the outer margins of the right lower lobe, middle lobe, and upper lobe.

An expert in respiratory medicine in Beijing analyzed a reporter from the China News Agency on the 6th. Alveolar epithelial cells were necrotic, desquamated, and bronchial tubes were covered with mucus and bleeding exudates. These were also reflected in other reports. However, cases of pulmonary hemorrhage are rarely seen clinically, and this report states that "the surface of the entire lung is bronze and diffuse congestion is visible to the naked eye", which does not rule out bleeding caused during lung transplantation.

The expert further analyzed that the mechanism of neocoronavirus-induced respiratory failure has not yet been determined, or the virus directly caused inflammation, or the immune overshoot caused by it. And Ding Yanqing, a pathology professor at Southern Medical University, said that the "cytokine storm" was an important cause of acute respiratory distress and multiple organ failure in patients with SARS (Severe Acute Respiratory Syndrome). Cytokine storm caused. "

How does a pathology report help clinical treatment?

On February 28, the "Large Observation Report on the Anatomy of a New Coronary Virus Pneumonia Dead Corpse System", led by Liu Liang, a professor of the Department of Forensic Medicine of Tongji Medical College of Huazhong University of Science and Technology, was officially released. "A large number of sticky secretions overflowed from the alveoli and fibrous strands were seen on the section." The report suggests that neocoronary pneumonia mainly causes inflammatory reactions characterized by deep airway and alveolar damage.

For the general anatomy report published by Liu Liang's team, Luo Fengming, a professor of respiratory and critical care medicine at the West China Hospital of Sichuan University, and some other experts believe that "to help clinical work, such as the problem of airway mucus plugs." Some experts also raised different opinions. Yang Lianjun, director of the Department of Pathology of the National Emergency General Hospital, bluntly stated in the interview: "It is only a general observation under the naked eye, no pathological analysis under a microscope, and clinical guidance is of little significance."

The National Health and Health Commission of China released the "New Coronavirus Pneumonia Diagnosis and Treatment Program (Trial Version 7)" for the first time and added the "pathological changes" part, which is derived from the current limited autopsy and puncture tissue pathological observation results. "Clinically, it is (can) be targeted to find the disease and deal with it in a targeted manner." Liu Liang told the media that he may reduce the severity of illness to critical illness, and then reduce mortality.

Zeng Guang, chief scientist of epidemiology at the Chinese Center for Disease Control and Prevention, also said in an interview with a reporter from China News Agency that pathological anatomy found that organs other than the lungs were affected by the virus. "This is important for treatment, medication, and judgment of cure."

Yi Xianghua, director of the Department of Pathology, Tongji Hospital, Tongji University, based on known pathological analysis, makes recommendations for clinical treatment: First, while giving respiratory support to patients, especially critically ill patients, care should be taken to protect other organs. Second, we must take necessary measures to restore the patient's immune function; third, we must attach importance to the pathological changes of small blood vessels throughout the patient and reduce the formation of microthrombus.

In what ways will the "scalpel" advance?

At present, Liu Liang's team has completed the pathological anatomy of the bodies of 9 deceased patients with new coronary pneumonia, and is doing further research. In an interview with a China News Agency reporter on the 4th, he emphasized that clinical pathological results can only be used as a reference and targeted treatment should be performed according to the patient's own situation.

An expert in respiratory medicine in Beijing said that the autopsy report reflects the end state of a disease. Only by performing organ biopsy at different stages can a complete pathological report be obtained and a comprehensive understanding of the new crown virus.

Zheng Ruiqiang, director of the Department of Critical Care Medicine, Subei People's Hospital, pointed out that the pathological manifestations of different patients will vary due to different disease courses and treatment methods. Clinical guidance will be more targeted. "

Experts also noticed that the smallest of the 11 currently donated corpses was also 52 years old and that there were individual differences in autopsy. According to this, on the one hand, 11 cases of autopsy pathological anatomy should be collected from as many organs and parts as possible. After the general observation, microscope observation, molecular detection observation and research are needed; on the other hand, they call for more donated corpses To analyze the cases of sudden exacerbation and death after treatment for a period of time, may be more useful for clinical reference. (Finish)