新型冠状病毒感染致呼吸系统损伤的研究进展

doi:10.19983/j.issn.2096-8493.2024041

摘要/Abstract

摘要：

新型冠状病毒感染(coronavirus disease 2019,COVID-19)因为细胞因子风暴等原因导致急性炎症,发生急性呼吸窘迫综合征、呼吸衰竭等临床症状,对呼吸系统造成潜在的长期影响。重症患者可能会发生肺间质纤维化,造成永久性肺损伤,对生命健康造成严重影响。新型冠状病毒不断变异,至今已经演化出多种变异株,且具有更强的传播力和致病性。笔者主要对COVID-19导致呼吸系统损伤的病理特征和机制、主要临床表现和治疗及预后进行综述,旨在提高人们对COVID-19导致呼吸系统损伤的认识。

关键词: 冠状病毒感染, 呼吸系统, 总结性报告

Abstract:

When SARS-CoV-2 infects the respiratory system, it induces a cytokine storm leading to acute inflammation, acute respiratory distress syndrome (ARDS), respiratory failure, and other clinical manifestations, potentially exerting a long-term impact on respiratory health. In severe cases, the infection may lead to pulmonary interstitial fibrosis, resulting in permanent lung damage that profoundly affects individuals’ health and quality of life. The SARS-CoV-2 is in a state of continuous mutation, giving rise to various mutant strains with enhanced transmissibility and virulence. This review primarily consolidates the pathological features, mechanisms, principal clinical manifestations, therapeutic interventions, and prognostic outcomes associated with respiratory system damage caused by SARS-CoV-2 infection. The objective of this review is to enhance the understanding of the respiratory impairments linked to SARS-CoV-2.

Key words: Coronavirus infections, Respiratory system, Consensus development conference

中图分类号:

徐思芸, 陆霓虹. 新型冠状病毒感染致呼吸系统损伤的研究进展[J]. 结核与肺部疾病杂志, 2024, 5(3): 267-272. doi: 10.19983/j.issn.2096-8493.2024041

Xu Siyun, Lu Nihong. Research progress of respiratory system injury caused by novel coronavirus[J]. Journal of Tuberculosis and Lung Disease, 2024, 5(3): 267-272. doi: 10.19983/j.issn.2096-8493.2024041

图/表 1

参考文献 44

[1]	Lu R, Zhao X, Li J, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet, 2020, 395(10224):565-574. doi:10.1016/S0140-6736(20)30251-8. pmid: 32007145
[2]	World Health Organization. WHO COVID-19 Dashboard. Geneva: World Health Organization, 2023.
[3]	He X, Hong W, Pan X, et al. SARS-CoV-2 Omicron variant: Characteristics and prevention. MedComm (2020), 2021, 2(4):838-845. doi:10.1002/mco2.110.
[4]	Zhao Y, Zhao Z, Wang Y, et al. Single-Cell RNA Expression Profiling of ACE2, the Receptor of SARS-CoV-2. Am J Respir Crit Care Med, 2020, 202(5):756-759. doi:10.1164/rccm.202001-0179LE.
[5]	Hoffmann M, Kleine-Weber H, Schroeder S, et al. SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor. Cell, 2020, 181(2):271-280.e8. doi:10.1016/j.cell.2020.02.052. pmid: 32142651
[6]	Jackson CB, Farzan M, Chen B, et al. Mechanisms of SARS-CoV-2 entry into cells. Nat Rev Mol Cell Biol, 2022, 23(1):3-20. doi:10.1038/s41580-021-00418-x.
[7]	Jiang S, Hillyer C, Du L. Neutralizing Antibodies against SARS-CoV-2 and Other Human Coronaviruses: (Trends in Immunology 41, 355-359; 2020). Trends Immunol, 2020, 41(6):545. doi:10.1016/j.it.2020.04.008. pmid: 32362491
[8]	Ziegler CGK, Allon SJ, Nyquist SK, et al. SARS-CoV-2 Receptor ACE 2 Is an Interferon-Stimulated Gene in Human Airway Epithelial Cells and Is Detected in Specific Cell Subsets across Tissues. Cell, 2020, 181(5):1016-1035.e19. doi:10.1016/j.cell.2020.04.035. pmid: 32413319
[9]	Triposkiadis F, Starling RC, Xanthopoulos A, et al. The Counter Regulatory Axis of the Lung Renin-Angiotensin System in Severe COVID-19: Pathophysiology and Clinical Implications. Heart Lung Circ, 2021, 30(6):786-794. doi:10.1016/j.hlc.2020.11.008.
[10]	Hussman JP. Cellular and Molecular Pathways of COVID-19 and Potential Points of Therapeutic Intervention. Front Pharmacol, 2020,11:1169. doi:10.3389/fphar.2020.01169.
[11]	Choudhury A, Mukherjee S. In silico studies on the comparative characterization of the interactions of SARS-CoV-2 spike glycoprotein with ACE-2 receptor homologs and human TLRs. J Med Virol, 2020, 92(10):2105-2113. doi:10.1002/jmv.25987.
[12]	Liu J, Li S, Liu J, et al. Longitudinal characteristics of lymphocyte responses and cytokine profiles in the peripheral blood of SARS-CoV-2 infected patients. EBioMedicine, 2020,55:102763. doi:10.1016/j.ebiom.2020.102763.
[13]	Chen G, Wu D, Guo W, et al. Clinical and immunological features of severe and moderate coronavirus disease 2019. J Clin Invest, 2020, 130(5):2620-2629. doi:10.1172/JCI137244. pmid: 32217835
[14]	Verma S, Abbas M, Verma S, et al. Impact of I/D polymorphism of angiotensin-converting enzyme 1 (ACE1) gene on the severity of COVID-19 patients. Infect Genet Evol, 2021,91:104801. doi:10.1016/j.meegid.2021.104801.
[15]	Barbayianni I, Kanellopoulou P, Fanidis D, et al. SRC and TKS5 mediated podosome formation in fibroblasts promotes extracellular matrix invasion and pulmonary fibrosis. Nat Commun, 2023, 14(1):5882. doi:10.1038/s41467-023-41614-x.
[16]	Hirawat R, Jain N, Aslam Saifi M, et al. Lung fibrosis: Post-COVID-19 complications and evidences. Int Immunopharmacol, 2023,116:109418. doi:10.1016/j.intimp.2022.109418.
[17]	中华人民共和国国家卫生健康委员会办公厅, 中华人民共和国国家中医药管理局综合司. 新型冠状病毒感染诊疗方案(试行第十版). 中国医药, 2023, 18(2): 161-166. doi:10.3760/j.issn.1673-4777.2023.02.001.
[18]	Writing Committee for the COMEBAC Study Group, Morin L, Savale L, et al. Four-Month Clinical Status of a Cohort of Patients After Hospitalization for COVID-19. JAMA, 2021, 325(15):1525-1534. doi:10.1001/jama.2021.3331. pmid: 33729425
[19]	Li X, Shen C, Wang L, et al. Pulmonary fibrosis and its related factors in discharged patients with new corona virus pneumonia: a cohort study. Respir Res, 2021, 22(1):203. doi:10.1186/s12931-021-01798-6.
[20]	刘茜, 王荣帅, 屈国强, 等. 新型冠状病毒肺炎死亡尸体系统解剖大体观察报告. 法医学杂志, 2020, 36(1):21-23. doi:10.12116/j.issn.1004-5619.2020.01.005.
[21]	Fan Y, Li X, Zhang L, et al. SARS-CoV-2 Omicron variant: recent progress and future perspectives. Signal Transduct Target Ther, 2022, 7(1):141. doi:10.1038/s41392-022-00997-x.
[22]	Miyashita N, Nakamori Y, Ogata M, et al. Comparison of pneumonia severity scores for COVID-19 patients with the Omicron variant. J Infect Chemother, 2024, 30(5):463-466. doi:10.1016/j.jiac.2023.11.007.
[23]	Märkl B, Dintner S, Schaller T, et al. Fatal cases after Omicron BA.1 and BA.2 infection: Results of an autopsy study. Int J Infect Dis, 2023, 128:51-57. doi:10.1016/j.ijid.2022.12.029.
[24]	Chakraborty C, Sharma AR, Bhattacharya M, et al. A Detailed Overview of Immune Escape, Antibody Escape, Partial Vaccine Escape of SARS-CoV-2 and Their Emerging Variants With Escape Mutations. Front Immunol, 2022,13:801522. doi:10.3389/fimmu.2022.801522.
[25]	Pham T, Rubenfeld GD. Fifty Years of Research in ARDS. The Epidemiology of Acute Respiratory Distress Syndrome. A 50th Birthday Review. Am J Respir Crit Care Med, 2017, 195(7):860-870. doi:10.1164/rccm.201609-1773CP.
[26]	Hendrickson KW, Peltan ID, Brown SM. The Epidemiology of Acute Respiratory Distress Syndrome Before and After Coronavirus Disease 2019. Crit Care Clin, 2021, 37(4):703-716. doi:10.1016/j.ccc.2021.05.001. pmid: 34548129
[27]	Peltan ID, Caldwell E, Admon AJ, et al. Characteristics and Outcomes of US Patients Hospitalized With COVID-19. Am J Crit Care, 2022, 31(2):146-157. doi:10.4037/ajcc2022549.
[28]	Chien JY, Hsueh PR, Cheng WC, et al. Temporal changes in cytokine/chemokine profiles and pulmonary involvement in severe acute respiratory syndrome. Respirology, 2006, 11(6):715-722. doi:10.1111/j.1440-1843.2006.00942.x.
[29]	ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA, 2012, 307(23):2526-2533. doi:10.1001/jama.2012.5669. pmid: 22797452
[30]	Gosangi B, Rubinowitz AN, Irugu D, et al. COVID-19 ARDS: a review of imaging features and overview of mechanical ventilation and its complications. Emerg Radiol, 2022, 29(1):23-34. doi:10.1007/s10140-021-01976-5.
[31]	Wiener-Kronish JP, Albertine KH, Matthay MA. Differential responses of the endothelial and epithelial barriers of the lung in sheep to Escherichia coli endotoxin. J Clin Invest, 1991, 88(3):864-875. doi:10.1172/JCI115388. pmid: 1885774
[32]	Leppkes M, Knopf J, Naschberger E, et al. Vascular occlusion by neutrophil extracellular traps in COVID-19. EBioMedicine, 2020,58:102925. doi:10.1016/j.ebiom.2020.102925.
[33]	Song WC, FitzGerald GA. COVID-19, microangiopathy, hemostatic activation, and complement. J Clin Invest, 2020, 130(8):3950-3953. doi:10.1172/JCI140183.
[34]	Yang K, Liu S, Yan H, et al. SARS-CoV-2 spike protein receptor-binding domain perturbates intracellular calcium homeostasis and impairs pulmonary vascular endothelial cells. Signal Transduct Target Ther, 2023, 8(1):276. doi:10.1038/s41392-023-01556-8.
[35]	Arachchillage DRJ, Laffan M. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost, 2020, 18(5):1233-1234. doi:10.1111/jth.14820. pmid: 32291954
[36]	Schulman S, Hu Y, Konstantinides S. Venous Thromboembolism in COVID-19. Thromb Haemost, 2020, 120(12):1642-1653. doi:10.1055/s-0040-1718532.
[37]	Tanni SE, Fabro AT, de Albuquerque A, et al. Pulmonary fibrosis secondary to COVID-19: a narrative review. Expert Rev Respir Med, 2021, 15(6):791-803. doi:10.1080/17476348.2021.1916472.
[38]	Wu B, Huang M, Jiao G, et al. Lung transplantation during the outbreak of Coronavirus Disease 2019 in China. J Thorac Cardiovasc Surg, 2022, 163(1):326-335.e6. doi:10.1016/j.jtcvs.2020.10.154.
[39]	Kiener M, Roldan N, Machahua C, et al. Human-Based Advanced in vitro Approaches to Investigate Lung Fibrosis and Pulmonary Effects of COVID-19. Front Med (Lausanne), 2021,8:644678. doi:10.3389/fmed.2021.644678.
[40]	Gulati A, Lakhani P. Interstitial lung abnormalities and pulmonary fibrosis in COVID-19 patients: a short-term follow-up case series. Clin Imaging, 2021, 77:180-186. doi:10.1016/j.clinimag.2021.03.030.
[41]	Davis HE, Assaf GS, McCorkell L, et al. Characterizing long COVID in an international cohort: 7 months of symptoms and their impact. EClinicalMedicine, 2021,38:101019. doi:10.1016/j.eclinm.2021.101019.
[42]	Gao YD, Ding M, Dong X, et al. Risk factors for severe and critically ill COVID-19 patients: A review. Allergy, 2021, 76(2):428-455. doi:10.1111/all.14657.
[43]	Egan JJ, Martinez FJ, Wells AU, et al. Lung function estimates in idiopathic pulmonary fibrosis: the potential for a simple classification. Thorax, 2005, 60(4):270-273. doi:10.1136/thx.2004.035436. pmid: 15790978
[44]	du Bois RM, Albera C, Bradford WZ, et al. 6-Minute walk distance is an independent predictor of mortality in patients with idiopathic pulmonary fibrosis. Eur Respir J, 2014, 43(5):1421-1429. doi:10.1183/09031936.00131813. pmid: 24311766