全球新型冠状病毒感染(COVID-19)相关死亡的病理变化及死因分析  

Pathological Changes and Cause of Death Associated with the Global Novel Coro⁃navirus Disease (COVID-19)

作　　者：杨彬 徐璐瑶 李灵玥 乔东访 杜思昊 岳霞 王慧君 YANG Bin;XU Lu-yao;LI Ling-yue;QIAO Dong-fang;DU Si-hao;YUE Xia;WANG Hui-jun(Department of Forensic Pathology,School of Forensic Medicine,Southern Medical University,Forensic Science Center of Southern Medical University,Guangzhou 510515,China)

机构地区：[1]南方医科大学法医学院法医病理学系南方医科大学司法鉴定中心,广东广州510515

出　　处：《法医学杂志》2023年第6期586-595,共10页Journal of Forensic Medicine

摘　　要：新型冠状病毒感染(coronavirus disease 2019,COVID-19)已在全球流行超过3年,造成690多万人死亡。COVID-19具有强传染性和长潜伏期的临床特点,能造成以肺损伤为主的多系统损伤,临床出现急性呼吸窘迫综合征以及全身多器官损伤症状,其病毒SARS-Co V-2仍在不断变异。目前全球对COVID-19相关死亡的病理改变乃至于死因判断标准并未达成共识,调查该疾病的基本病变和病变进展,有助于指导临床治疗以及治疗药物的研制。本文综述了全球2020年2月至2023年6月发表的COVID-19尸体检验报告及相关文献,以有明确的尸体检验案例数量以及对应的重要器官病理学改变为纳入标准,共纳入来自18个国家65篇论文的1 111例尸体检验案例,对病理表现和死因进行归类和统计学分析,归纳和总结了COVID-19的共性病理变化,并提出分析结论 ,认为COVID-19感染能引起全身重要器官发生危及生命的病理改变,在感染群体健康水平各异的基础上,死亡案例的直接死因主要为严重的肺部损伤及其继发的全身多器官功能衰竭。The coronavirus disease 2019(COVID-19)has been a global epidemic for more than three years,causing more than 6.9 million deaths.COVID-19 has the clinical characteristics of strong infec‐tivity and long incubation period,and can cause multi-system damage,mainly lung damage,clinical symptoms of acute respiratory distress syndrome(ARDS)and systemic multiple organ damage.The SARS-CoV-2 virus is still constantly mutating.At present,there is no global consensus on the patho‐logical changes of COVID-19 associated deaths and even no consensus on the criteria for determining the cause of death.The investigation of the basic pathological changes and progression of the disease is helpful to guide the clinical treatment and the development of therapeutic drugs.This paper reviews the autopsy reports and related literature published worldwide from February 2020 to June 2023,with a clear number of autopsy cases and corresponding pathological changes of vital organs as the inclu‐sion criteria.A total of 1111 autopsy cases from 65 papers in 18 countries are included.Pathological manifestations and causes of death are classified and statistically analyzed,common pathological changes of COVID-19 are summarized,and analytical conclusions are drawn,suggesting that COVID-19 infec‐tion can cause life-threatening pathological changes in vital organs.On the basis of different health levels of infected groups,the direct cause of death is mainly severe lung damage and secondary sys‐temic multiple organ failure.

关 键 词：法医病理学 新型冠状病毒感染 尸体检验 死亡原因 弥漫性肺泡损伤 多器官功能衰竭 病理变化 综述 

分 类 号：R89[医药卫生—法医学] DF795.1[医药卫生—临床医学] D919.1[政治法律—诉讼法学]