Гистопатологическая оценка биопсий и тканей хирургических резекций толстого кишечника у пациентов с COVID-19 (SARS-CoV-2)

Цель. Гистопатологическая оценка биопсий и тканей хирургических резекций толстого кишечника у пациентов с COVID-19 (SARS-CoV-2).

Материалы и методы. Проведен ретроспективный анализ биопсий/резекций толстого кишечника 116 пациентов с положительным результатом ПЦР-теста назофарингеального мазка на SARS-CoV-2, полученным в течение 12 недель до проведения биопсии/резекции без установленного диагноза заболевания ЖКТ в анамнезе. Срезы тканей оценивали с помощью стандартной световой микроскопии, ткани биопсии/резекции окрашивали гематоксилином и эозином по стандартному протоколу. При оценке гистоморфологии срезов были оценены пять категорий, отражающих тяжесть гистопатологического повреждения: 1) гистоархитектоника слизистой оболочки, 2) эпителиальные изменения, 3) состав и размер воспалительных клеточных инфильтратов, 4) количество эозинофилов, 5) микрососудистые изменения. Для каждого гистологического признака дополнительно отмечались наличие или отсутствие признака или степень выраженности повреждения. Случаи были сгруппированы по совокупности гистологических признаков принадлежности к морфологическим паттернам: 1) острый воспалительный паттерн, 2) ишемический паттерн, 3) ВЗК-подобный паттерн.

Результаты и обсуждение. В 10 (8.6%) случаях был выявлен паттерн острого воспалительного повреждения: эрозии и язвы, крипт-абсцессы, гиперплазия эпителия, очаговые и диффузные скопления полиморфноядерных гранулоцитов. В 62 (53.4%) случаях были выявлены гистологические признаки ишемического паттерна: искажения гистоархитектоники, атрофия крипт и поверхностный некроз/регенерация слизистой оболочки с формированием грануляционной ткани, микрососудистые изменения. В 17 (14.7%) случаях был обнаружен паттерн повреждения, ассоциирующийся со спектром ВЗК, характеризующийся изменениями/деформацией гистоархитектоники, метаплазией/гиперплазией клеток Панета, деструктивным повреждением эпителия со смешанной полиморфноядерной гранулоцитарной и трансмуральной лимфоплазмоцитарной инфильтрацией с лимфоидными скоплениями в толще всей стенки кишечника и базальным плазмоцитозом.

Заключение. Исследование выявило высокую частоту встречаемости ишемического паттерна повреждения толстой кишки у пациентов в течение 12 недель после перенесенного COVID-19 и ряд случаев ВЗК-подобным паттерном повреждения кишечника. Полученные данные могут помочь в стратификации групп пациентов с гистопатологическими признаками повреждения кишечника после COVID-19 и показывают актуальность проведения расширенных перспективных исследований.

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