新型冠状病毒感染神经精神并发症的发病机制

Nikolay A. Klimov, O. Shamova
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摘要

由 SARS-CoV-2 冠状病毒引起的感染在相当多的患者中表现为神经和精神并发症,这些并发症的基础是血脑屏障的通透性被破坏、促炎细胞因子渗入大脑、神经炎症和凝血病变。对急性期死亡患者大脑的研究表明,血管周围存在炎症病灶,其中含有巨噬细胞和少量 CD8+ T 细胞。小胶质细胞、肥大细胞、巨噬细胞和内皮细胞参与了神经炎症的发展。在脑组织样本中观察到小胶质细胞结节,表明神经噬噬和神经元丢失。一些 SARS-CoV-2 蛋白,特别是 S 蛋白,对神经元具有致病性。COVID-19 患者脑脊液中的生化标记物--NfL(神经丝蛋白轻链)和 GFAp(胶质纤维酸性蛋白)表明轴突遭到破坏,星形胶质细胞受损。许多 COVID-19 患者会出现自身抗原抗体,包括一些中枢神经系统受体,并因免疫功能紊乱和分子模仿而引发脑炎。在阿尔茨海默病和帕金森病患者中,冠状病毒感染会加重这些疾病的症状。本综述旨在总结分析急性冠状病毒感染(COVID-19)和COVID后综合征神经精神并发症免疫发病机制的文献资料。
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Pathogenesis of neuropsychic complications of new coronavirus infection
Infection caused by the SARS-CoV-2 coronavirus is characterized by neurological and mental complications in a significant number of patients, which are based on disruption of the permeability of the blood-brain barrier, penetration of pro-inflammatory cytokines into the brain, neuroinflammation and coagulopathy. Studies of the brains of patients who died during an acute period of the disease showed a presence of foci of perivascular inflammation containing macrophages and, in a small number, CD8+ T cells. Microglial cells, mast cells, macrophages, and endothelial cells are involved in the development of neuroinflammation. Microglial nodules were observed in brain tissue samples, indicating neurophagia and neuronal loss. Some SARS-CoV-2 proteins, in particular the S protein, have pathogenic properties towards neurons. Biochemical markers in the cerebrospinal fluid of COVID-19 patients — NfL (neurofilament light chain) and GFAp (glial fibrillary acidic protein) indicate axonal destruction and astrocyte damage. Many patients with COVID-19, develop autoantibodies to self-antigens, including some CNS receptors, and encephalitis due to immune dysfunction and molecular mimicry. In patients with Alzheimer’s disease and Parkinson’s disease, coronavirus infection increases the symptoms of these diseases. The purpose of the review is summarizing the literary data for the analysis of immunopathogenesis of neuropsychic complications of acute coronavirus infection (COVID-19) and post-COVID syndrome.
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