The lancet novel coronavirus pneumonia is the first report of the world's first new pneumonia report.

Authors: Wang Fangxin crown pneumonia (COVID-19) is an acute disease, which can cause severe alveolar damage and progressive respiratory failure At present, scientists have revealed the structure, potential treatment and transmission route of sars-cov-2 to some extent, but it is also important to understand how the virus destroys our body, so as to "suit the case" On February 16, with the consent of family members, Wuhan Jinyintan hospital completed the autopsy of two patients with covid-19 At present, the autopsy cases have been sent for examination The results will be obtained 10 days later (February 26), which is of great significance to explore the clinical pathological changes and disease mechanism of patients with covid-19 Two days later, Wang Fusheng, academician team of the fifth medical center of the General Hospital of the Chinese people's Liberation Army, published a pathological report on the remains of a covid-19 patient in the famous international medical journal the lancet respiratory medicine, which provided an important reference for people to understand the pathogenesis of the disease Https://doi.org/10.1016/s2213-2600 (20) 30076-x male patient died 14 days after onset The patient, a 50 year old male, visited Wuhan at the beginning of January, had mild chills and dry coughs on January 14 (the first day of illness), and went to the hospital on January 21 (the eighth day of illness) due to fever, chills, coughs, fatigue and shortness of breath Chest X-ray showed multiple patchy shadows in both lungs Real time reverse transcription PCR (reverse real-time PCR) test confirmed that the patient had covid-19 According to the course schedule based on the number of days of the first onset of the disease and the number of days after admission, during hospitalization, the patient received supplemental oxygen therapy, interferon α - 2b and antiviral treatment with lopinavir + ritonavir, as well as moxifloxacin injection to prevent secondary infection Later, the patient's shortness of breath worsened and hypoxemia occurred, so he received intravenous methylprednisolone After treatment, the body temperature dropped from 39 ℃ to 36.4 ℃, but the symptoms of cough, dyspnea and fatigue were not improved With the aggravation of the condition, the claustrophobic patient received high flow nasal catheter (hfnc) oxygen therapy, but the situation did not improve, and finally died of ineffective rescue at 18:31 p.m on January 27, Beijing time Similar to SARS and mers, sars-cov-2 attacks the lungs In the study, researchers took biopsies from patients' lungs, liver and heart tissues Chest X-ray showed rapid development of pneumonia, in which the right lung showed the loss of lung cells and the formation of hyaline membrane The left lung showed pulmonary edema with hyaline membrane formation, indicating that the patient had acute respiratory distress syndrome (ARDS), which was very similar to the pathological characteristics of SARS and mers patients In addition, the liver tissue showed moderate microvascular steatosis and mild lobular activity, but there was no conclusive evidence that sars-cov-2 infection or drug-induced liver injury No obvious histological changes were found in the heart tissue, indicating that sars-cov-2 infection may not directly damage the heart Pathological features of right lung (a), left lung (b), liver (c) and heart (d) in patients Although a review published online on February 7 in the lancet noted that clinical evidence does not support the use of glucocorticoids in the treatment of covid-19, from the pathological features of pulmonary edema and hyaline membrane formation observed in this latest study, the researchers still suggest that corticosteroids and respirators should be considered for severe patients at an appropriate time The results of flow cytometry showed that the number of CD4 and cd8t cells in the blood was significantly reduced, but the state was over activated, which showed the increase of Th17 and the high cytotoxicity of cd8t cells, which indicated that the immune system of patients was seriously damaged The researchers suggest that lymphopenia is a common feature of patients with covid-19, which may be a key factor related to disease severity and mortality In this regard, a report released online by medrxiv, a research team from Beijing Ditan Hospital Affiliated to Capital Medical University, on February 12, mentioned that the ratio of neutrophils to lymphocytes (NLR) is an early identification factor of critical illness of covid-19, and the patients with age ≥ 50 and NLR ≥ 3.13 are more likely to develop into critical illness After the outbreak of SARS in 2003, the pathological anatomy of the patients made an important contribution to the understanding of the causes, pathogenesis, treatment and protective measures of SARS The new report also provides important insights into the pathogenesis of covid-19, and will help clinicians to formulate treatment strategies for similar severe patients in time, so as to save more patients' lives Reference materials: [1] hereditary findings of covid-19 associated with acute respiratory syndrome [2] nuclear to lymphocyte ratio predictions severe illness patients with 2019 new coronavirus in the early stage