COVID-19的发病机制提示治疗策略

Infectious diseases & immunity Pub Date : 2021-04-20 eCollection Date: 2021-04-01 DOI:10.1097/ID9.0000000000000005
Tai-Sheng Li, Ling Lin
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引用次数: 0

摘要

2019冠状病毒病是21世纪又一重大病毒性传染病大流行。自2019年12月在中国武汉报告首例病例以来,COVID-19已导致1亿多例确诊病例和200多万人死亡。COVID-19一直被认为是由SARS-CoV-2感染引起的全身性炎症反应综合征,主要以肺部病变为主。大多数患者症状轻微,预后良好,但严重或危重病例可导致死亡。否则,就没有有效的抗病毒药物来治疗COVID-19。除了病原体和传播途径等基本要素外,探索新型传染病的发病机制也非常重要。通过查阅文献和观察临床患者,我们于2020年3月首次提出了covid -19的潜在发病机制。病毒首先通过鼻黏膜和咽喉黏膜,然后通过呼吸道进入肺部。早期感染最常见的症状是发烧和咳嗽。随后,病毒可从肺部进入外周血,引起病毒血症。然后,病毒攻击表达血管紧张素转换酶2的目标器官,如肺、心脏、肾脏和胃肠道。这样,病毒开始第二次攻击,导致患者病情在发病后7至14天恶化。据此,我们将COVID-19病程分为三个阶段(图1):病毒血症期、急性(肺炎)期、恢复期,部分患者由急性(肺炎)期进入重症期。COVID-19患者淋巴细胞随着病情进展逐渐减少,炎症因子表达增加,形成炎症因子风暴。此外,重症患者还观察到肢体末端的缺血性改变。结合实验室凝血因子异常,可见部分重症患者存在凝血功能障碍。基于COVID-19的潜在发病机制和患者的临床表现,在疾病早期进行免疫干预可能为患者提供更多机会
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