新型冠状病毒对循环系统影响的研究进展

王曦; 安松涛; 李文博; 陈东昌; 孟华

doi:10.16766/j.cnki.issn.1674-4152.001792

新型冠状病毒对循环系统影响的研究进展

doi: 10.16766/j.cnki.issn.1674-4152.001792

1.
河南大学人民医院河南省人民医院心内科，河南郑州 450003
2.
华中阜外心血管病医院河南省人民医院心脏中心，河南郑州 450003

基金项目:

国家自然科学基金资助项目 81970312

河南省自然科学基金资助项目 182300410304

详细信息

通讯作者:
安松涛，E-mail: ansongtao2010@163.com

中图分类号: R563.1
计量
- 文章访问数: 188
- HTML全文浏览量: 97
- PDF下载量: 6
- 被引次数: 0
出版历程
- 收稿日期: 2020-08-15
- 网络出版日期: 2022-02-19

Research progress of the effect of SARS-CoV-2 on the circulatory system

1.
Department of Cardiology, Hennan University People's Hospital, Henan Provincial People's Hospital, Henan, Zhengzhou 450003, China

摘要

摘要: 新型冠状病毒肺炎(coronavirus disease 2019，COVID-19)是由新型冠状病毒(SARS-CoV-2)引起的，以发热、咳嗽及呼吸困难为主要临床症状的一种可在人群中广泛传播的疾病。截至目前，2019新型冠状病毒已在全球范围内造成大流行，随着国内疫情防治工作的有效开展，以及对于新型冠状病毒肺炎的认识与研究不断加深，发现很多新冠肺炎患者出现以循环系统损害症状为首发或继发的临床症状。SARS-CoV-2可直接通过血管紧张素转换酶2 (angiotensin converting enzyme 2，ACE2)受体损伤心肌细胞，也可以通过异常激活免疫系统、释放大量细胞因子从而导致急、慢性的心肌损伤。当心功能受损严重时，可能会通过RAS系统影响到肾脏功能，从而导致患者同时出现心脏和肾脏损害的临床表现。此外，对于COVID-19患者来说，还存在着动、静脉血栓栓塞的风险。本文结合近日来公布的新冠肺炎病例的资料和各团队最新的研究发现，对新型冠状病毒对于循环系统影响的研究进展做一简要概述，以期为进一步了解新型冠状病毒感染对循环系统的损害提供帮助。
- 新型冠状病毒 /
- 新型冠状病毒肺炎 /
- 循环系统
Abstract: Coronavirus disease 2019 (COVID-19) is caused by a novel coronavirus (SARS-CoV-2). It is a disease that can spread widely amongst the population with fever, cough, and dyspnea as the main clinical symptoms. To date, SARS-CoV-2 is causing a pandemic. With the effective development of domestic epidemic prevention and control and the understanding and research of the new type of coronavirus pneumonia, many patients with new coronary pneumonia have been discovered to have clinical symptoms that are first or secondary to symptoms of circulatory system damage. SARS-CoV-2 can directly damage cardiomyocytes through angiotensin converting enzyme 2 receptors. It can also activate the immune system abnormally and release a large number of cytokines to cause acute and chronic myocardial damage. When the heart function is severely impaired, kidney function may be affected through the RAS system, which may lead to clinical manifestations of heart and kidney damage at the same time. For COVID-19 patients, risks of arterial and venous thromboembolism also exist. This article combines the data of the new coronary pneumonia cases announced in recent days and the latest findings of research teams to provide a brief overview of the study progress of the new coronavirus on the circulatory system. We aim to better elucidate the damage to the circulatory system caused by the new coronavirus infection.
- SARS-CoV-2 /
- COVID-19 /
- Circulatory system

HTML全文

参考文献(52)

[1]	WANG D W, HU B, HU C, et al. Clinical characteristics of 138 hospitalized patients with 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China[J]. JAMA, 2020, 323(11): 1061-1069. doi: 10.1001/jama.2020.1585
[2]	LU R, ZHAO X, LI J, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding[J]. Lancet, 2020, 395(10224): 565-574. doi: 10.1016/S0140-6736(20)30251-8
[3]	ZHU N, ZHANG D Y, WANG W L, et al. A novel coronavirus from patients with pneumonia in China, 2019[J]. N Engl J Med, 2020, 382(8): 727-733. doi: 10.1056/NEJMoa2001017
[4]	LESCURE FX, BOUADMA L, NGUYEN D, et al. Clinical and virological data of the first cases of COVID-19 in Europe: a case series[J]. Lancet Infect Dis, 2020, 20(6): 697-706. doi: 10.1016/S1473-3099(20)30200-0
[5]	国家卫生健康委员会. 新型冠状病毒感染的肺炎诊疗方案(试行第七版)[EB/OL]. (2020-03-04)[2020-07-18]. http://www.nhc.gov.cn/xcs/zhengcwj/202003/46c9294a7dfe4cef80dc7f5912eb1989.shtml.
[6]	GUAN W J, NI Z Y, HU Y, et al. Clinical characteristics of coronavirus disease 2019 in China[J]. N Engl J Med, 2020, 382(18): 1708-1720. doi: 10.1056/NEJMoa2002032
[7]	DENG S Q, PENG H J. Characteristics of and public health responses to the coronavirus disease 2019 outbreak in China[J]. J Clin Med, 2020, 9(2): 575. doi: 10.3390/jcm9020575
[8]	ZHU G L, ZHU C M, ZHU Y, et al. Minireview of progress in the structural study of SARS-CoV-2 proteins[J]. Curr Res Microb Sci, 2020, 1(6): 53-61. http://www.sciencedirect.com/science/article/pii/S2666517420300079
[9]	ZOU X, CHEN K, ZOU J W, et al. Single-cell RNA-seq data analysis on the receptor ACE2 expression reveals the potential risk of different human organs vulnerable to 2019-nCoV infection[J]. Front Med, 2020, 14(2): 185-192. doi: 10.1007/s11684-020-0754-0
[10]	LU R J, ZHAO X, LI J, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding[J]. Lancet, 2020, 395(10224): 565-574. doi: 10.1016/S0140-6736(20)30251-8
[11]	ZHOU P, YANG X L, WANG X G, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin[J]. Nature, 2020, 579(7798): 270-273. doi: 10.1038/s41586-020-2012-7
[12]	HUANG C, WANG Y, LI X, et al Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China [J]. Lancet, 2020, 395(10223): 497-506. doi: 10.1016/S0140-6736(20)30183-5
[13]	CHEN N, ZHOU M, DONG X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study[J]. Lancet, 2020, 395(10223): 507-513. doi: 10.1016/S0140-6736(20)30211-7
[14]	LI B, YANG J, ZHAO F, et al. Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China[J]. Clin Res Cardiol, 2020, 109(5): 531-538. doi: 10.1007/s00392-020-01626-9
[15]	HUI D S C, ZUMLA A. Severe acute respiratory syndrome historical, epidemiologic, and clinical features [J]. Infect Dis Clin N Am, 2019, 33(4): 869-889. doi: 10.1016/j.idc.2019.07.001
[16]	王倩文, 王晞, 王龙. 新型冠状病毒感染对心血管系统的损伤作用及其机制研究进展[J]. 山东医药, 2020, 60(18): 99-102. doi: 10.3969/j.issn.1002-266X.2020.18.028
[17]	LIU Y X, YANG Y, ZHANG C, et al. Clinical and biochemical indexes from 2019-nCoV infected patients linked to viral loads and lung injury[J]. Sci China Life Sci, 2020, 63(3): 364-374. doi: 10.1007/s11427-020-1643-8
[18]	XU X T, CHEN P, WANG J F, et al. Evolution of the novel coronavirus from the ongoing Wuhan outbreak and modeling of its spike protein for risk of human transmission[J]. Sci China Life Sci, 2020, 63(3): 457-460. doi: 10.1007/s11427-020-1637-5
[19]	BOSKABADI J, ASKARI VR, HOSSEINI M, et al. Immunomodulatory properties of captopril, an ACE inhibitor, on LPS-induced lung inflammation and fibrosis as well as oxidative stress[J]. Inflammopharmacology, 2019, 27(3): 639-647. doi: 10.1007/s10787-018-0535-4
[20]	程克斌, 魏明, 沈虹, 等. 普通型和重型新型冠状病毒肺炎康复患者463例临床特征分析[J]. 上海医学, 2020, 43(4): 224-232. https://www.cnki.com.cn/Article/CJFDTOTAL-SHYX202004015.htm
[21]	LIPPI G, PLEBANI M. Laboratory abnormalities in patients with COVID-2019 infection[J]. Clin Chem Lab Med, 2020, 58(7): 1131-1134. doi: 10.1515/cclm-2020-0198
[22]	LIPPI G, LAVIE C J, SANCHIS-GOMAR F. Cardiac troponin I in patients with coronavirus disease 2019 (COVID-19): Evidence from a meta-analysis[J]. Prog Cardiovasc Dis, 2020, 63(3): 390-391. doi: 10.1016/j.pcad.2020.03.001
[23]	DENG S Q, PENG H J. Characteristics of and public health responses to the coronavirus disease 2019 outbreak in China[J]. J Clin Med, 2020, 9(2), 575-585. doi: 10.3390/jcm9020575
[24]	尹立雪, 李春梅, 谢明星, 等. 新型冠状病毒肺炎患者床旁超声心动图检查及远程超声会诊实施建议(第一版)[J]. 中华超声影像学杂志, 2020, 29(3): 192-205. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHCD202003019.htm
[25]	罗晶晶, 董念国, 史嘉玮. 新型冠状病毒感染相关心脏损害的机制探讨[J]. 临床心血管病杂志, 2020, 36(4): 307-310. https://www.cnki.com.cn/Article/CJFDTOTAL-LCXB202004003.htm
[26]	ZUMLA A, HUI D S, AZHAR E I, et al. Reducing mortality from 2019-nCoV: host-directed therapies should be an option[J]. Lancet, 2020, 395(10224): e35-e36. doi: 10.1016/S0140-6736(20)30305-6
[27]	XU Z, SHI L, WANG Y J, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome[J]. Lancet Respir Med, 2020, 8(4): 420-422. doi: 10.1016/S2213-2600(20)30076-X
[28]	BUCKLEY L F, CANADA J M, CARBONE S, et al. Potential role for interleukin-1 in the cardio-renal syndrome[J]. Eur J Heart Fail, 2019, 21(3): 385-386. doi: 10.1002/ejhf.1403
[29]	LI X C, ZHANG J F, ZHUO J L. The vasoprotective axes of the renin-angiotensin system: Physiological relevance and therapeutic implications in cardiovascular, hypertensive and kidney diseases[J]. Pharmacol Res, 2017, 125(9): 21-38. http://europepmc.org/abstract/MED/28619367
[30]	CULVER S, LI C, SIRAGY H M. Intrarenal angiotensin-converting enzyme: the old and the new[J]. Curr Hypertens Rep, 2017, 19(10): 80. doi: 10.1007/s11906-017-0778-2
[31]	NAYOR M, LARSON MG, WANG N, et al. The association of chronic kidney disease and microalbuminuria with heart failure with preserved vs. reduced ejection fraction[J]. Eur J Heart Fail, 2017, 19(5): 615-623. doi: 10.1002/ejhf.778
[32]	RANGASWAMI J, BHALLA V, BLAIR JEA, et al. Cardiorenal syndrome: classification, pathophysiology, diagnosis, and treatment strategies: a scientific statement from the american heart association[J]. Circulation, 2019, 139(16): e840-e878. http://www.ncbi.nlm.nih.gov/pubmed/30852913
[33]	CLARKE B. Cardiorenal interactions, diuretic resistance, and acute heart failure: renal response vs renal function[J]. Can J Cardiol, 2019, 35(9): 1079-1081. doi: 10.1016/j.cjca.2019.02.020
[34]	TOCCI G, CITONI B, PRESTA V, et al. Effects of dual inhibition of renin-angiotensin-aldosterone system on cardiovascular and renal outcomes: balancing the risks and the benefits[J]. Internal and emergency medicine, 2020, 15(3): 373-379. doi: 10.1007/s11739-019-02257-3
[35]	LYTVYN Y, GODOY L C, SCHOLOTES R A, et al. Mineralocorticoid antagonism and diabetic kidney disease[J]. Curr Diab Rep, 2019, 19(1): 4. doi: 10.1007/s11892-019-1123-8
[36]	GANT C M, LAVERMAN G D, Vogt L, et al. Renoprotective RAAS inhibition does not affect the association between worse renal function and higher plasma aldosterone levels[J]. BMC Nephrol, 2017, 18(1): 370. doi: 10.1186/s12882-017-0789-x
[37]	KOMERS R, PLOTKIN H. Dual inhibition of renin-angiotensin-aldosterone system and endothelin-1 in treatment of chronic kidney disease[J]. Am J Physiol Regul Integr Comp Physiol, 2016, 310(10): R877-884. doi: 10.1152/ajpregu.00425.2015
[38]	UMANATH K, LEWIS J B. Update on diabetic nephropathy: core curriculum 2018[J]. Am J Kidney Dis, 2018, 71(6): 884-895. doi: 10.1053/j.ajkd.2017.10.026
[39]	张中, 殷召, 毛帅, 等. COVID-19心脏损伤的可能机制与治疗[J]. 中国循证心血管医学杂志, 2020, 12(2) : 155-157. doi: 10.3969/j.issn.1674-4055.2020.02.07
[40]	KOW C S, ZAIDI STR, HASAN S S. Cardiovascular disease and use of renin-angiotensin system inhibitors in COVID-19[J]. Am J Cardiovasc Drugs, 2020, 20(3): 217-221. doi: 10.1007/s40256-020-00406-0
[41]	MEHRA M R, DESAI S S, KUY S R, et al. Cardiovascular disease, drug therapy, and mortality in COVID-19[J]. N Engl J Med, 2020, 382(25): e102. doi: 10.1056/NEJMoa2007621
[42]	MANCIA G, REA, LUDERGNANI M, et al. Renin-angiotensin-aldosterone system blockers and the risk of COVID-19[J]. N Engl J Med, 2020, 382(25): 2431-2440. doi: 10.1056/NEJMoa2006923
[43]	REYNOLDS H R, ADHIKARI S, PULGARIN C, et al. Renin-angiotensin-aldosterone system Inhibitors and risk of COVID-19[J]. N Engl J Med, 2020, 382(25): 2441-2448. doi: 10.1056/NEJMoa2008975
[44]	LEVI M, VANDER P T. Coagulation and sepsis[J]. Thromb Res, 2017, 149(1): 38-44.
[45]	SCHMITT FCF, MANOLOV V, MORGENSTERN J, et al. Acute fibrinolysis shutdown occurs early in septic shock and is associated with increased morbidity and mortality: results of an observational pilot study[J]. Ann Intensive Care, 2019, 9(1): 19. doi: 10.1186/s13613-019-0499-6
[46]	GUPTA N, ZHAO Y Y, EVANS C E. The stimulation of thrombosis by hypoxia[J]. Thromb Res, 2019, 181(9): 77-83. http://www.sciencedirect.com/science/article/pii/S0049384819302956
[47]	REN B, YAN F F, DENG Z M, et al. Extremely high incidence of lower extremity deep venous thrombosis in 48 patients with severe COVID-19 in Wuhan[J]. Circulation, 2020, 142(2): 181-183. doi: 10.1161/CIRCULATIONAHA.120.047407
[48]	DOMINGUEZ-ERQUICIA P, DOBARRO D, RAPOSEIRAS-ROUBIN S, et al. Multivessel coronary thrombosis in a patient with COVID-19 pneumonia[J]. Eur Heart J, 2020, 41(22): 2132. doi: 10.1093/eurheartj/ehaa393
[49]	PARANIPE I, FUSTER V, LALA A, et al. Association of treatment dose anticoagulation with In-hospital survival among hospitalized patients with COVID-19[J]. J Am Coll Cardiol, 2020, 76(1): 122-124. doi: 10.1016/j.jacc.2020.05.001
[50]	中华医学会呼吸病学分会肺栓塞与肺血管病学组等. 新型冠状病毒肺炎相关静脉血栓栓塞症防治建议(试行)[J/OL]. 中华医学杂志, 2020, 100(11): 808-813. doi: 10.3760/cma.j.cn112137-20200209-00227
[51]	OTOSHI T, KATAOKA Y, NAKAGAWA A, et al. Clinical features and outcomes of diffuse alveolar hemorrhage during antithrombotic therapy: a retrospective cohort study[J]. Lung, 2016, 194(3): 475-581. doi: 10.1007/s00408-016-9873-4
[52]	赵家鑫, 陈巍, 刘嘉琳, 等. 新型冠状病毒肺炎合并心血管疾病的抗栓策略[J]. 中国动脉硬化杂志, 2020, 28(5): 373-381. doi: 10.3969/j.issn.1007-3949.2020.05.003