瑞德西韦治疗冠状病毒感染的研究进展

2019年12月,由2019新型冠状病毒(2019-novel coronavirus,2019-nCoV)感染导致的新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)于我国武汉暴发,成为全球近十几年来,继严重急性呼吸综合征(severe acute respiratory syndrome,SARS)和中东呼吸综合征(Middle East respiratory syndrome,MERS)之后第3次暴发的冠状病毒疫情。本次COVID-19疫情传播迅速、广泛,病毒传染性强,但目前尚无针对2019-nCoV的特异性药物。瑞德西韦(remdesivir)属于核苷类似物抗病毒药,在细胞实验和动物模型上均显示出抗SARS-CoV和抗MERS-CoV活性,且在治疗埃博拉病毒感染的多中心随机对照临床试验中未见明显不良反应。因此,该药被认为是治疗2019-nCoV感染极有潜力的药物。本文对瑞德西韦治疗CoV感染的研发历程和潜在临床应用作一综述。     

病毒性脓毒症的发病机制及其对严重急性呼吸综合征冠状病毒2脓毒症治疗的指导意义

新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)自2019年12月起在中国湖北省武汉市出现并开始传播,其病原体为严重急性呼吸综合征冠状病毒2(severe acute respiratory syndrome coronavirus 2,SARS-CoV-2)。截至2020年2月17日,确诊病例已超过7万,仅湖北就有近6万,且尚未看到拐点。世界卫生组织已经宣布COVID-19为全球关注的公共卫生紧急事件。COVID-19患者的主要临床症状是发热、乏力、干咳等,而重症患者多在一周后就出现呼吸困难,并快速进展为急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)、脓毒性休克、多器官功能障碍,危重症患者多死于脓毒性休克和多器官功能障碍。因此,本文将回顾病毒性脓毒症的流行病学、免疫学发病机制和潜在的治疗方法,以期提高对SARS-CoV-2脓毒症发病机制的认识,并为SARS-CoV-2脓毒症和脓毒性休克的治疗提供新思路和策略。     

SARS-CoV-2 抗体不同方法学检测结果的差异分析

新型冠状病毒肺炎(corona virus disease 2019,COVID-19)是由严重急性呼吸综合征冠状病毒2(severe acute respiratory syndrome coronavirus 2,SARS-CoV-2)感染引起的新发传染病。《新型冠状病毒肺炎诊疗方案(试行第七版)》将血清SARS-CoV-2特异性IgM和IgG抗体阳性作为确诊依据之一^[1]。目前,已有多种方法的商品化SARS-CoV-2抗体检测试剂。本研究拟采用胶体金法和化学发光法对发热患者血清SARS-CoV-2抗体进行检测,并对2种方法检测不一致的结果进行分析。     

新型冠状病毒肺炎合并严重ARDS的重要手段——ECMO治疗

2019年新型冠状病毒(SARS-Cov-2)疫情在湖北武汉暴发。有文献报道,新型冠状病毒肺炎(简称:新冠肺炎)患者中,危重症患者的病死率较高,其中60岁以上患者占多数,且存在合并症者死亡率更高[1]。新冠肺炎死亡患者肺部病理呈急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)改变[2]。     

传染性非典型肺炎抗体的检测及其临床意义评价

1 引言 传染性非典型肺炎亦称为严重急性呼吸综合征(severe acute respiratory syndrome,SARS),是一种由新型冠状病毒引起的急性呼吸系统传染病.     

重症新型冠状病毒肺炎:是急性呼吸窘迫综合征吗？

新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)在全球暴发流行,危害严重。虽然目前临床研究和尸检结果提高了人们对COVID-19的认识,但仍存在诸多争议,最大的争议之一即为重症COVID-19是否可诊断为急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)。重症COVID-19符合ARDS柏林标准,但与其他原因导致的ARDS存在诸多不同之处,包括发病晚、部分患者肺顺应性相对正常、高碳酸血症出现较早、肺CT表现和肺凝血活化明显。目前对COVID-19相关ARDS的分型多基于观察性研究,偏倚较大。至今其病理生理过程尚未明确,过早分型可能误导机械通气策略,期待大样本临床研究结果带来更多证据。     

传染性非典型肺炎的监护

1 引言传染性非典型肺炎(非典)又称严重急性呼吸综合征 (severe acute respiratory syndrome,SARS),是一种由变异冠状病毒感染引起的新的呼吸道传染性疾病。自2002年11 月首次在我国广东地区报告以来,全球先后有33个国家和地区受累,截至2004-03-31,报告病例8 443例(其中     

重症新型冠状病毒肺炎呼吸治疗流程专家建议

新型冠状病毒肺炎以发热、干咳、乏力为主要表现,多数患者在1周后出现呼吸困难,严重者快速发展为急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)。国家卫生健康委发布的《新型冠状病毒感染的肺炎重症、危重症病例诊疗方案(试行)》[1]中关于重症和危重症的主要临床诊断标准即为存在不同严重程度ARDS需要呼吸支持治疗。     

新型冠状病毒肺炎诊断的相关实验室检测技术应用

2019年底暴发的新型冠状病毒肺炎(COVID-19)已成全球蔓延态势,对世界公共卫生安全造成了重大威胁。实验室检测在COVID-19诊治全过程都具有重要价值。目前,严重急性呼吸综合征冠状病毒2(SARSCoV-2)核酸检测仍是诊断COVID-19的金标准。文章对COVID-19的确诊、鉴别诊断及辅助诊断相关实验室检测技术的原理、优缺点、现有研究情况、结果判读等问题进行综述,以期为临床医生及检验工作者提供参考。     

SARS并发多器官功能障碍综合征的机制及救治对策

严重急性呼吸综合征( severe acute respiratory syndrome,SARS)由新型冠状病毒引起〔1〕。SARS具有毒性大、传染性强,能以多种形式和途径使人受染、有一定潜伏期、不易被察觉,作用范围大等特点。到2 0 0 3年6月6日,全世界确诊SARS病例840 3例,死亡775例,大多是死于多器官功能障碍综合征( multiple organdysfunction syndrome,MODS)及多器官衰竭( multiple organ failure,MOF)。研究SARS患者并发MODS的机制及救治对策已是当务之急。1　SARS患者并发MODS的机制探讨1 .1　SARS患者并发MODS死亡病例的病理学特点:1肺间质严重…     

Clinical features and potential mechanism of coronavirus disease 2019-associated liver injury

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, has posed a serious threat to global public health security. With the increase in the number of confirmed cases globally, the World Health Organization has declared the outbreak of COVID-19 an international public health emergency. Despite atypical pneumonia as the primary symptom, liver dysfunction has also been observed in many clinical cases and is associated with the mortality risk in patients with COVID-19, like severe acute respiratory syndrome and Middle East respiratory syndrome. Here we will provide a schematic overview of the clinical characteristics and the possible mechanisms of liver injury caused by severe acute respiratory syndrome coronavirus 2 infection, which may provide help for optimizing the management of liver injury and reducing mortality in COVID-19 patients.     

新型冠状病毒感染的临床表现及其实验室检测技术进展

新型冠状病毒(SARS-CoV-2)属于冠状病毒属,是一种主要通过呼吸道传播的RNA病毒,具有极高传染性,被世界卫生组织列为对人类危害最严重的病毒之一。目前尚无批准上市的用于预防SARS-CoV-2的疫苗,该病毒导致的2019年新型冠状病毒肺炎(COVID-19)需要通过实验室检测才能明确。为了解SARS-CoV-2的研究进展,该文综述了该病毒的特征、感染的流行病学、实验室检测技术,以期为诊断和防控新型冠状病毒病提供参考。     

Tension pneumomediastinum and diffuse subcutaneous emphysema with severe acute respiratory syndrome coronavirus 2 infection requiring operative management for impending airway collapse: A case report

Tension pneumomediastinum is a rare complication of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection that has increased in incidence with the novel coronavirus disease 2019 pandemic. Although traditionally managed with conservative measures, we present the indications and methods for the first operative management of tension pneumomediastinum with concomitant SARS‐CoV‐2 infection.     

Cross-protective immunity following coronavirus vaccination and coronavirus infection

Although severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines have shown efficacy against SARS-CoV-2, it is unknown if coronavirus vaccines can also protect against other coronaviruses that may infect humans in the future. Here, we show that coronavirus vaccines elicited cross-protective immune responses against heterologous coronaviruses. In particular, we show that a severe acute respiratory syndrome coronavirus 1 (SARS-CoV-1) vaccine developed in 2004 and known to protect against SARS-CoV-1 conferred robust heterologous protection against SARS-CoV-2 in mice. Similarly, prior coronavirus infections conferred heterologous protection against distinct coronaviruses. Cross-reactive immunity was also reported in patients with coronavirus disease 2019 (COVID-19) and in individuals who received SARS-CoV-2 vaccines, and transfer of plasma from these individuals into mice improved protection against coronavirus challenges. These findings provide the first demonstration to our knowledge that coronavirus vaccines (and prior coronavirus infections) can confer broad protection against heterologous coronaviruses and establish a rationale for universal coronavirus vaccines.     

Healthy neonate born to a SARS-CoV-2 infected woman: A case report and review of literature

BACKGROUNDSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a newly discovered coronavirus that has generated a worldwide outbreak of infections. Many people with coronavirus disease-2019 (COVID-19) have developed severe illness, and a significant number have died. However, little is known regarding infection by the novel virus in pregnant women. We herein present a case of COVID-19 confirmed in a woman delivering a neonate who was negative for SARS-CoV-2 and related it to a review of the literature on pregnant women and human coronavirus infections.CASE SUMMARYThe patient was a 36-year-old pregnant woman in her third trimester who had developed progressive clinical symptoms when she was confirmed as infected with SARS-CoV-2. Given the potential risks for both the pregnant woman and the fetus, an emergency cesarean section was performed, and the baby and his mother were separately quarantined and cared for. As a result, the baby currently shows no signs of SARS-CoV-2 infection (his lower respiratory tract samples were negative for the virus), while the mother completely recovered from COVID-19.CONCLUSIONAlthough we presented a single case, the successful result is of great significance for pregnant women with SARS-CoV-2 infection and with respect to fully understanding novel coronavirus pneumonia.     

新型冠状病毒肺炎基本再生数的初步预测

目的预测新型冠状病毒感染肺炎(2019-nCoV)的基本再生数,为其防控和相关政策支持提供依据。方法基于包括"易感态-潜伏态-感染态-移除态"的SEIR仓室模型,假设2020年1月25日及以前出现症状的感染者均属于无干预自由传播期间感染的人员,结合截至1月26日凌晨已确诊和疑似病例数及国际同行预测的感染人数,参考SARS的流行病学关键参数,对新型冠状病毒感染肺炎的基本再生数进行估计。结果以《人民日报》和丁香园发布的新型冠状病毒感染肺炎疫情实时动态数据为基准,估计2019-nCoV的基本再生数在2.8~3.3之间;以国外同行预测的感染人数为基准,基本再生数在3.2~3.9之间。结论 2019-nCoV早期致病传播能力与SARS接近或略高于SARS,属于中高度传染性的传播疾病。迅速切断传播途径,采用及时有效的防控措施能够较快遏制2019-nCoV的进一步蔓延。     

Theory and reality of antivirals against SARS-CoV-2

At present, over 180 million people have been infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) worldwide and there have been more than 3.8 million deaths due to the virus. However, specific effective antiviral treatment for this infectious disease is absent. At the beginning of the epidemic, relevant cellular and animal experiments of antiviral treatment for SARS-CoV-2 were conducted based on the prior studies of SARS-CoV and Middle East respiratory syndrome coronavirus. Some antivirals were preliminarily validated to be potentially effective in the clinical settings. But as the epidemic continued and more studies were carried out, the efficacy of these antiviral drugs became controversial. This paper reviews the pharmacology and application of interferon, lopinavir/ritonavir, ribavirin, chloroquine, arbidol, favipiravir, remdesivir, and thymosin α1 in coronavirus disease 2019. The actual effect of these drugs remains controversial. Meanwhile, the efficacy and safety of these drugs for patients with coronavirus disease 2019 still need to be explored.     

临床生化检验指标在COVID-19疾病进展及治疗中的应用评价

新型冠状病毒(SARS-CoV-2)引发新型冠状病毒肺炎(COVID-19)的流行,该病为新发的传染病,其来源、病理机制等诸多方面尚未完全清楚。该病的诊断、变化及治疗评价需要检验提供重要的依据,该病在发生、发展过程中会引起肺、肾脏、肝脏、心脏等多器官损伤,而这些器官是否受损及受损的程度依赖临床检验的结果。该文重点阐述COVID-19发生、发展及治疗过程中合理选择实验室检查项目及检查结果的临床意义,以期为该病的准确治疗、疾病进展、疗效评估等提供理论依据。     

冠状病毒疾病2019发病机制若干热点问题的思考

严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）所致冠状病毒疾病2019（COVID-19）已构成国际关注的突发公共卫生事件。COVID-19传染性强,可导致患者出现严重呼吸道感染和多器官系统功能损害。COVID-19发病机制尚不明确,我们推测SARS-CoV-2直接致宿主靶细胞损伤及机体免疫炎症反应紊乱可能是COVID-19的主要致病机制。本文基于相关研究领域的进展,对COVID-19发病机制中的若干热点问题进行分析和讨论,并提出思考。