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Sympathetic-Immune Interactions during Different Types of Immune Challenge. 在不同类型的免疫挑战中交感免疫相互作用。
IF 2.2 4区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-01-01 Epub Date: 2023-11-26 DOI: 10.1159/000535467
Adriana Del Rey, Hugo Besedovsky

Background: The neuro-endocrine regulation of immune functions is based on a complex network of interactions. As part of this series of articles, we refer here to immune-sympathetic interactions that are triggered by different types of immune challenge.

Summary: We mention the initial hypothesis that led to the proposal that the sympathetic nervous system (SNS) is involved in immunoregulation. We next refer mainly to our initial work performed at a time when most immunologists were concentrated in clarifying aspects of the immune system that are essential for its regulation from within. The first approach was to explore whether immune responses to innocuous antigens and superantigens can elicit changes in the activity of the SNS, and their potential relevance for the regulation of the activity of the immune system. The following step was to explore whether comparable immune-SNS interactions are detected in different models of diseases with immune components, such as parasitic and viral infections and autoimmune pathologies.

Key messages: We pose some general considerations that may at least partially explain seemly discrepant findings, and remark the importance of interpreting immunoregulatory effects of the SNS together with other neuro-endocrine inputs that simultaneously occur when the activity of the immune system changes. Finally, we provide some arguments to re-consider the use of the expression "reflex" in immunology.

背景:免疫功能的神经内分泌调节是基于一个复杂的相互作用网络。作为本系列文章的一部分,我们在这里提到由不同类型的免疫挑战触发的免疫-交感相互作用。摘要:我们提到了导致交感神经系统(SNS)参与免疫调节的提议的最初假设。接下来,我们主要参考我们最初的工作,当时大多数免疫学家都集中在阐明免疫系统的各个方面,这些方面对其内部调节至关重要。第一种方法是探索对无害抗原和超抗原的免疫反应是否会引起SNS活性的变化,以及它们与免疫系统活性调节的潜在相关性。接下来的步骤是探索是否在具有免疫成分的疾病的不同模型中检测到类似的免疫- sns相互作用,例如寄生虫和病毒感染以及自身免疫性病理。关键信息:我们提出了一些一般的考虑,至少可以部分解释看似不同的发现,并注意到解释SNS与其他神经内分泌输入的免疫调节作用的重要性,这些输入在免疫系统活性改变时同时发生。最后,我们提供了一些论据来重新考虑“反射”一词在免疫学中的使用。
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引用次数: 0
Brain-Thymus Connections in Chagas Disease. 南美锥虫病中的脑-hymus 连接。
IF 2.2 4区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-01-01 Epub Date: 2024-04-09 DOI: 10.1159/000538220
Florencia Belén González, Wilson Savino, Ana Rosa Pérez

Background: The brain and the immune systems represent the two primary adaptive systems within the body. Both are involved in a dynamic process of communication, vital for the preservation of mammalian homeostasis. This interplay involves two major pathways: the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system.

Summary: The establishment of infection can affect immunoneuroendocrine interactions, with functional consequences for immune organs, particularly the thymus. Interestingly, the physiology of this primary organ is not only under the control of the central nervous system (CNS) but also exhibits autocrine/paracrine regulatory circuitries mediated by hormones and neuropeptides that can be altered in situations of infectious stress or chronic inflammation. In particular, Chagas disease, caused by the protozoan parasite Trypanosoma cruzi (T. cruzi), impacts upon immunoneuroendocrine circuits disrupting thymus physiology. Here, we discuss the most relevant findings reported in relation to brain-thymic connections during T. cruzi infection, as well as their possible implications for the immunopathology of human Chagas disease.

Key messages: During T. cruzi infection, the CNS influences thymus physiology through an intricate network involving hormones, neuropeptides, and pro-inflammatory cytokines. Despite some uncertainties in the mechanisms and the fact that the link between these abnormalities and chronic Chagasic cardiomyopathy is still unknown, it is evident that the precise control exerted by the brain over the thymus is markedly disrupted throughout the course of T. cruzi infection.

背景:大脑和免疫系统是人体内两个主要的适应系统。两者都参与了一个动态的交流过程,对维持哺乳动物的平衡至关重要。这种相互作用涉及两个主要途径:下丘脑-垂体-肾上腺(HPA)轴和交感神经系统(SNS)。摘要:感染的建立会影响免疫-神经-内分泌的相互作用,从而对免疫器官,尤其是胸腺产生功能性影响。有趣的是,这一主要器官的生理机能不仅受中枢神经系统(CNS)的控制,而且还表现出由激素和神经肽介导的自分泌/旁分泌调节回路,这些回路在感染压力或慢性炎症的情况下会发生改变。特别是由原生寄生虫克鲁斯锥虫引起的南美锥虫病会影响免疫神经内分泌回路,破坏胸腺的生理机能。在此,我们将讨论有关克鲁兹锥虫感染期间大脑与胸腺联系的最相关研究结果,以及它们对人类恰加斯病免疫病理学可能产生的影响:在克鲁兹锥虫感染期间,中枢神经系统通过涉及激素、神经肽和促炎细胞因子的复杂网络影响胸腺生理。尽管这些机制还存在一些不确定性,而且这些异常与 CCC 之间的联系仍不清楚,但显而易见的是,在整个克鲁兹锥虫感染过程中,大脑对胸腺的精确控制受到了明显干扰。
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引用次数: 0
Dimethyl Fumarate Modulates the Immune Environment and Improves Prognosis in the Acute Phase after Ischemic Stroke. 富马酸二甲酯能调节免疫环境,改善缺血性中风后急性期的预后。
IF 2.2 4区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-01-01 Epub Date: 2024-06-06 DOI: 10.1159/000539589
Chunrui Bo, Jingkai Li, Junjie Wang, Yaxin Zhang, Tao Wu, Mingyang Wang, Shiyue Hou, Yan Liang, Xiyue Zhang, Shufang Zhao, Huixue Zhang, Jianjian Wang, Lihua Wang, Lianmei Zhong

Introduction: Dimethyl fumarate (DMF) has shown potential for protection in various animal models of neurological diseases. However, the impact of DMF on changes in peripheral immune organs and the central nervous system (CNS) immune cell composition after ischemic stroke remains unclear.

Methods: Eight-week-old C57BL/6J mice with photothrombosis ischemia and patients with acute ischemic stroke (AIS) were treated with DMF. TTC staining, flow cytometry, and immunofluorescence staining were used to evaluate the infarct volume and changes in immune cells in the periphery and the CNS.

Results: DMF reduced the infarct volume on day 1 after PT. DMF reduced the percentages of peripheral immune cells, such as neutrophils, dendritic cells, macrophages, and monocytes, on day 1, followed by NK cells on day 3 and B cells on day 7 after PT. In the CNS, DMF significantly reduced the percentage of monocytes in the brain on day 3 after PT. In addition, DMF increased the number of microglia in the peri-infarct area and reduced the number of neurons in the peri-infarct area in the acute and subacute phases after PT. In AIS patients, B cells decreased in patients receiving alteplase in combination with DMF.

Conclusion: DMF can change the immune environment of the periphery and the CNS, reduce infarct volume in the acute phase, promote the recruitment of microglia and preserve neurons in the peri-infarct area after ischemic stroke.

简介:富马酸二甲酯(DMF)在多种神经系统疾病动物模型中显示出潜在的保护作用。然而,DMF对缺血性脑卒中后外周免疫器官和中枢神经系统(CNS)免疫细胞组成变化的影响仍不清楚:方法:用 DMF 治疗光栓(PT)缺血的八周龄 C57BL/6J 小鼠和急性缺血性脑卒中(AIS)患者。采用TTC染色法、流式细胞术和免疫荧光染色法评估梗死体积以及外周和中枢神经系统免疫细胞的变化:结果:DMF缩小了PT后第1天的梗死体积。DMF在PT后第1天降低了中性粒细胞、树突状细胞、巨噬细胞和单核细胞等外周免疫细胞的百分比,随后在第3天降低了NK细胞的百分比,在第7天降低了B细胞的百分比。在中枢神经系统中,DMF 在 PT 后第 3 天显著降低了脑内单核细胞的百分比。此外,在 PT 后的急性期和亚急性期,DMF 增加了梗死周围区域的小胶质细胞数量,减少了梗死周围区域的神经元数量。在AIS患者中,接受阿替普酶联合DMF治疗的患者B细胞减少:结论:DMF可改变缺血性脑卒中患者外周和中枢神经系统的免疫环境,减少急性期梗死体积,促进小胶质细胞的募集,保护梗死周围神经元。
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引用次数: 0
Cytokines in Cerebrospinal Fluid and Chronic Pain in Humans: Past, Present, and Future. 脑脊液中的细胞因子与人类慢性疼痛--过去、现在和未来。
IF 2.2 4区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-01-01 Epub Date: 2024-07-16 DOI: 10.1159/000540324
Alexander H C Rosenström, Jan-Pieter Konsman, Eva Kosek

Background: That neuroimmune interaction occurs in chronic pain conditions has been established for over a century, since the discovery of neurogenic inflammation in the periphery. However, the central aspects of neuroimmune interactions have not been fully appreciated until the late 1900s, when a growing interest in how cytokines in the cerebrospinal fluid (CSF) might be relevant in chronic pain conditions emerged. Since then, the field has evolved, and nowadays neuroinflammation is considered to be involved in the pathophysiology of chronic pain. Whether or not pain conditions can be called "neuroinflammatory" is a matter of debate. This review summarizes the results from studies investigating cytokines in the CSF in various pain conditions, and critically discusses neuroimmune aspects of pain conditions using previously proposed hallmarks of neuroinflammation as a framework.

Summary: Fifty-two papers were summarized and their results evaluated according to (a) the level of the measured cytokines in patients compared to controls, and (b) the correlation between cytokine level and pain intensity. A subdivision based on pain type was also conducted for each of the 52 studies. A total of 49 proteins have been studied in at least 5 studies, 21 of which were upregulated in a majority of studies. IL-8 was specifically upregulated in a majority of studies of nociceptive pain conditions. Regarding correlation to pain intensity, there is a scarcity of data but 31 proteins were upregulated and correlated with pain in at least one study. Of these, 24 proteins were negatively correlated with pain, and 7 were positively correlated. None of the most studied cytokines, such as TNF, IL-1b, IL-6, IL-8, CCL2/MCP1, BDNF, or bNGF, were consistently correlated to pain.

Key messages: There is sufficient evidence to say that chronic pain conditions come with an upregulation of several cytokines. However, the majority of correlations to symptomatology seem to be negative, indicating that the cytokines might play a protective role that has not been broadly considered. Calling chronic pain conditions neuroinflammatory seems wrong; instead, a more suitable term for depicting the findings would, perhaps, be to talk about neuroimmune activation.

背景 自从发现外周神经源性炎症以来,神经免疫相互作用在慢性疼痛病症中的发生已经有一个多世纪的历史了。然而,直到 20 世纪末,人们才充分认识到神经免疫相互作用的核心方面,当时人们对脑脊液中的细胞因子如何与慢性疼痛病症相关的兴趣日益浓厚。此后,这一领域不断发展,如今神经炎症被认为与慢性疼痛的病理生理学有关。疼痛病症是否可以被称为 "神经炎症 "还存在争议。本综述总结了对各种疼痛情况下脑脊液中细胞因子的研究结果,并以之前提出的神经炎症特征为框架,批判性地讨论了疼痛情况的神经免疫方面。摘要 对 52 篇论文进行了总结,并根据 a) 与对照组相比,患者体内所测细胞因子的水平,以及 b) 细胞因子水平与疼痛强度之间的相关性,对论文结果进行了细分。此外,还根据疼痛类型对 52 项研究中的每一项进行了细分。至少有 5 项研究对 49 种蛋白质进行了研究,其中 21 种蛋白质在大多数研究中被上调。在大多数有关痛觉疼痛的研究中,IL8 都被特别上调。关于与疼痛强度的相关性,虽然数据很少,但至少有一项研究发现 31 种蛋白质上调并与疼痛相关。其中,24 种蛋白质与疼痛呈负相关,7 种呈正相关。研究最多的细胞因子(如 TNF、IL1b、IL6、IL8、CCL2/MCP1、BDNF 或 bNGF)均与疼痛无关。关键信息 有足够的证据表明,慢性疼痛会导致多种细胞因子上调。然而,大多数细胞因子与症状的相关性似乎是负相关的,这表明细胞因子可能起到保护作用,而这一点尚未得到广泛考虑。将慢性疼痛称为神经炎症似乎是错误的;相反,描述研究结果的更合适的术语或许是神经免疫激活。
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引用次数: 0
2nd European Psychoneuroimmunology Network (EPN) Autumn School: The skin-brain axis and the breaking of barriers 第二届欧洲心理神经免疫学网络秋季学校:皮脑轴与屏障的打破
IF 2.4 4区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-08-28 DOI: 10.1159/000533642
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引用次数: 0
2nd European Psychoneuroimmunology Network Autumn School: The Skin-Brain Axis and the Breaking of Barriers. 第二届欧洲心理神经免疫学网络秋季学校:皮脑轴与障碍的打破。
IF 2.4 4区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-01-01 Epub Date: 2023-08-21 DOI: 10.1159/000533611
Eva Peters, Adriana Del Rey, Karsten Krüger, Christoph Rummel
aDepartment of Psychosomatic Medicine and Psychotherapy, Psychoneuroimmunology Laboratory, Justus-Liebig University Giessen, Giessen, And Universitätsmedizin-Charité, Berlin, Germany; bCenter for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Marburg, Germany; cInstitute for Physiology and Pathophysiology, University of Marburg, Marburg, Germany; dDepartment of Exercise Physiology and Sports Therapy, Justus Liebig University Giessen, Giessen, Germany; eInstitute of Veterinary Physiology and Biochemistry, Justus Liebig University Giessen, Giessen, Germany
{"title":"2nd European Psychoneuroimmunology Network Autumn School: The Skin-Brain Axis and the Breaking of Barriers.","authors":"Eva Peters,&nbsp;Adriana Del Rey,&nbsp;Karsten Krüger,&nbsp;Christoph Rummel","doi":"10.1159/000533611","DOIUrl":"10.1159/000533611","url":null,"abstract":"aDepartment of Psychosomatic Medicine and Psychotherapy, Psychoneuroimmunology Laboratory, Justus-Liebig University Giessen, Giessen, And Universitätsmedizin-Charité, Berlin, Germany; bCenter for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Marburg, Germany; cInstitute for Physiology and Pathophysiology, University of Marburg, Marburg, Germany; dDepartment of Exercise Physiology and Sports Therapy, Justus Liebig University Giessen, Giessen, Germany; eInstitute of Veterinary Physiology and Biochemistry, Justus Liebig University Giessen, Giessen, Germany","PeriodicalId":19133,"journal":{"name":"Neuroimmunomodulation","volume":"30 Suppl 1 ","pages":"3-7"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10627488/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10109350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Erratum. 勘误。
IF 2.4 4区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-01-01 Epub Date: 2023-09-18 DOI: 10.1159/000531806
{"title":"Erratum.","authors":"","doi":"10.1159/000531806","DOIUrl":"10.1159/000531806","url":null,"abstract":"","PeriodicalId":19133,"journal":{"name":"Neuroimmunomodulation","volume":"30 1","pages":"213-214"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10308955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
15th Conference of the German Endocrine-Brain- Immune-Network (GEBIN) Ulm, Germany, September 28 - September 30, 2023. 德国内分泌脑免疫网络第15届会议,德国乌尔姆,2023年9月28日至9月30日。
IF 2.4 4区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-01-01 Epub Date: 2023-09-19 DOI: 10.1159/000533771
The abstracts included in this supplement were reviewed and selected by the Scientific Programme Committee. The committee has no conflicts of interest in connection with the congress and the selection of abstracts. Neuroimmunomodulation 2023;30(suppl 2):1–60 DOI: 10.1159/000533771 Published online: September 19, 2023 This article is licensed under the Creative Commons AttributionNonCommercial 4.0 International License (CCBY-NC) (http://www. karger.com/Services/OpenAccessLicense).Usage anddistribution for commercial purposes requires written permission.
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引用次数: 0
Understanding the Immune-Endocrine Effects of Vitamin D in SARS-CoV-2 Infection: A Role in Protecting against Neurodamage. 了解维生素D在严重急性呼吸系统综合征冠状病毒2型感染中的免疫内分泌作用:在预防神经损伤中的作用?
IF 2.2 4区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-01-01 Epub Date: 2023-08-09 DOI: 10.1159/000533286
Emanuele Gotelli, Stefano Soldano, Elvis Hysa, Andrea Casabella, Andrea Cere, Carmen Pizzorni, Sabrina Paolino, Alberto Sulli, Vanessa Smith, Maurizio Cutolo

Calcitriol and hydroxyderivatives of lumisterol and tachisterol are secosteroid hormones with immunomodulatory and anti-inflammatory properties. Since the beginning of the COVID-19 pandemic, several studies have correlated deficient serum concentrations of vitamin D3 (calcifediol) with increased severity of the course of SARS-CoV-2 infection. Among systemic complications, subjective (anosmia, ageusia, depression, dizziness) and objective (ischemic stroke, meningoencephalitis, myelitis, seizures, Guillain-Barré syndrome) neurological symptoms have been reported in up to 80% of severe COVID-19 patients. In this narrative review, we will resume the pathophysiology of SARS-CoV-2 infection and the mechanisms of acute and chronic neurological damage. SARS-CoV-2 can disrupt the integrity of the endothelial cells of the blood-brain barrier (BBB) to enter the nervous central system. Invasion of pro-inflammatory cytokines and polarization of astrocytes and microglia cells always in a pro-inflammatory sense together with the pro-coagulative phenotype of cerebral endothelial cells in response to both SARS-CoV-2 and immune cells invasion (immunothrombosis) are the major drivers of neurodamage. Calcitriol and hydroxyderivatives of lumisterol and tachisterol could play an adjuvant role in neuroprotection through mitigation of neuroinflammation and protection of endothelial integrity of the BBB. Dedicated studies on this topic are currently lacking and are desirable to confirm the link between vitamin D3 and neuroprotection in COVID-19 patients.

钙三醇和羽扇豆醇的羟基衍生物和大环己醇是具有免疫调节和抗炎特性的secosteroid激素。自新冠肺炎大流行开始以来,几项研究将维生素D3(骨化醇)的血清浓度不足与SARS-CoV-2感染过程的严重程度增加联系起来。在系统性并发症中,高达80%的新冠肺炎重症患者出现了主观(嗅觉缺失、老年痴呆、抑郁、眩晕)和客观(缺血性中风、脑膜脑炎、脊髓炎、癫痫发作、格林-巴利综合征)神经症状。在这篇叙述性综述中,我们将回顾严重急性呼吸系统综合征冠状病毒2型感染的病理生理学以及急性和慢性神经损伤的机制。严重急性呼吸系统综合征冠状病毒2型可以破坏血脑屏障内皮细胞进入神经中枢系统的完整性。促炎细胞因子的侵袭、星形胶质细胞和小胶质细胞的极化,以及脑内皮血管对严重急性呼吸系统综合征冠状病毒2型和免疫细胞侵袭(免疫血栓形成)的促凝表型,始终是促炎意义上的神经损伤的主要驱动因素。钙三醇和羽扇豆醇的羟基衍生物和大律师可以通过减轻神经炎症和保护血脑屏障内皮完整性,在神经保护中发挥辅助作用。目前缺乏关于这一主题的专门研究,希望证实维生素D3与新冠肺炎患者神经保护之间的联系。
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引用次数: 0
Neuropsychiatric Outcomes and Sleep Dysfunction in COVID-19 Patients: Risk Factors and Mechanisms. 新冠肺炎患者的神经精神结果和睡眠功能障碍:危险因素和机制。
IF 2.2 4区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-01-01 Epub Date: 2023-09-27 DOI: 10.1159/000533722
Aliki Karkala, Asterios Tzinas, Seraphim Kotoulas, Athanasios Zacharias, Evdokia Sourla, Athanasia Pataka

The ongoing global health crisis due to the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has significantly impacted all aspects of life. While the majority of early research following the coronavirus disease caused by SARS-CoV-2 (COVID-19) has focused on the physiological effects of the virus, a substantial body of subsequent studies has shown that the psychological burden of the infection is also considerable. Patients, even without mental illness history, were at increased susceptibility to developing mental health and sleep disturbances during or after the COVID-19 infection. Viral neurotropism and inflammatory storm damaging the blood-brain barrier have been proposed as possible mechanisms for mental health manifestations, along with stressful psychological factors and indirect consequences such as thrombosis and hypoxia. The virus has been found to infect peripheral olfactory neurons and exploit axonal migration pathways, exhibiting metabolic changes in astrocytes that are detrimental to fueling neurons and building neurotransmitters. Patients with COVID-19 present dysregulated and overactive immune responses, resulting in impaired neuronal function and viability, adversely affecting sleep and emotion regulation. Additionally, several risk factors have been associated with the neuropsychiatric sequelae of the infection, such as female sex, age, preexisting neuropathologies, severity of initial disease and sociological status. This review aimed to provide an overview of mental health symptoms and sleep disturbances developed during COVID-19 and to analyze the underlying mechanisms and risk factors of psychological distress and sleep dysfunction.

新型严重急性呼吸系统综合征冠状病毒2型(SARS-CoV-2)导致的持续全球健康危机严重影响了生活的方方面面。尽管大多数关于SARS-CoV-2(新冠肺炎)引起的冠状病毒疾病的早期研究都集中在病毒的生理影响上,但大量后续研究表明,感染的心理负担也相当大。即使没有精神病史的患者,在新冠肺炎感染期间或之后,也更容易出现精神健康和睡眠障碍。病毒性神经变性和破坏血脑屏障的炎症风暴已被认为是心理健康表现的可能机制,以及应激性心理因素和血栓形成和缺氧的间接后果。该病毒已被发现感染外周嗅觉神经元并利用轴突迁移途径,在星形胶质细胞中表现出代谢变化,不利于为神经元提供能量和构建神经递质。新冠肺炎患者出现免疫反应失调和过度活跃,导致神经元功能和生存能力受损,对睡眠和情绪调节产生不利影响。此外,一些风险因素与感染的神经精神后遗症有关,如女性、年龄、先前存在的神经病理学、初始疾病的严重程度和社会学状况。这篇综述旨在概述2019冠状病毒病期间出现的心理健康症状和睡眠障碍,并分析心理困扰和睡眠功能障碍的潜在机制和风险因素。
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引用次数: 0
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Neuroimmunomodulation
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