新型冠状病毒肺炎心肌损伤临床病理与影像学研究进展

由新型冠状病毒(SARS-CoV-2)感染引起的新型冠状病毒肺炎(COVID-19)严重威胁人类健康。随着确诊病例数增加和研究深入,发现COVID-19主要侵犯呼吸系统,还可累及心肌及其他重要脏器。本文对COVID-19相关心肌损伤的病理生理学机制、临床特征、影像学评估等进行综述,以期为COVID-19患者心肌损伤的早期诊治及预后评估提供帮助。     

新型冠状病毒肺炎和心血管疾病关系的研究进展

当前,由严重急性呼吸综合征冠状病毒2(SARS-CoV-2)引发的新型冠状病毒肺炎(COVID-19)疫情在全球蔓延。SARS-CoV-2主要通过血管紧张素转换酶2(ACE2)受体感染宿主细胞,在引起呼吸系统损伤的同时,也造成急性心肌损伤和慢性心血管疾病。COVID-19患者合并心血管疾病也十分常见,对患者的预后有显著影响,需要提高认识和积极防治。本文综述了COVID-19合并及继发心血管疾病的流行病学特征、相互影响机制及治疗和预防措施,以增进临床医师对COVID-19和心血管疾病关系的认识和管理。     

新型冠状病毒肺炎与心肌损伤

2019年12月,我国武汉地区爆发新型冠状病毒肺炎(novel coronavirus pneumonia,COVID-19)。现已有近8万例临床诊断患者,死亡2700余例。随着临床病例资料的不断丰富,研究人员发现新型冠状病毒肺炎患者除了具有典型的呼吸系统表现外,也出现了心肌损伤、爆发性心肌炎、心源性休克和心功能衰竭等与病毒感染相关的心脏损害症状。合并高血压、冠心病的新型冠状病毒肺炎患者,更易发展为重症患者,死亡风险更高。本文基于现有文献报道,就新型冠状病毒肺炎与心肌损伤的相关机制和防治策略进行初步探讨。     

新型冠状病毒肺炎相关心肌损伤的临床管理专家建议(第一版)

新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)患者除了典型呼吸系统表现,也有一定比例的患者出现心脏受累的临床表现。心肌损伤在COVID-19患者中比较常见,发生心肌损伤的患者预后不佳,心脏内科专科医师进行及时诊断、明确心肌损伤的发生原因、采取针对性的治疗,可降低重型及危重型COVID-19患者的死亡率。本专家组结合收治经验,针对COVID-19相关心肌损伤提出诊断和治疗建议。     

老年重症新型冠状病毒肺炎患者护理专家共识

目的新型冠状病毒(2019-nCoV)因2019年12月发生在武汉的不明原因病毒性肺炎病例而被发现,由该病原感染所致的肺炎称为新型冠状病毒肺炎(COVID-19)。虽然2019-nCoV对于人群普遍易感,但老年人由于免疫力低下且合并基础疾病较多,使得该组人群感染后病情进展更快、严重程度更高,重症及危重症患者较多。为进一步提高老年重症COVID-19患者的护理质量、减少并发症、降低死亡率,我们组织国内老年重症护理专家在文献回顾和专家研讨的基础上编写该共识,该共识涵盖老年重症COVID-19患者的评估、临床护理、出院护理等相关内容,以期为临床实践提供借鉴与指导。     

糖尿病患者易感新型冠状病毒的免疫因素分析

2019年底由新型冠状病毒感染(COVID-19)引起的肺炎引起全球公共卫生关注。流行病学研究显示,有基础病的老年人更易感,COVID-19合并基础病患者中糖尿病患者占20. 9%,病死率为7. 3%,糖尿病患者因代谢负荷导致机体炎性损伤、免疫失衡,增加了COVID-19的风险。本文就糖尿病并发/合并症、天然免疫、T/B细胞功能失衡、慢性炎症及血管紧张素转化酶2表达紊乱等方面,对糖尿病患者易感新型冠状病毒的免疫因素进行分析,为COVID-19的防治提供依据。     

新型冠状病毒肺炎患者肝损伤的机制及中医防治探究

截至4月12日,新型冠状病毒播散至全球211个国家和地区,累计174余万人确诊新型冠状病毒肺炎(COVID-19),超过10万人因感染而死亡,对公众健康造成严重威胁[1]。许多患者除呼吸系统损伤外,还表现不同程度的肝脏损伤[2,3],及时修复患者肝损伤,有利于肺炎患者的康复[4]。1 COVID-19患者肝损伤的机制许多COVID-19患者存在不同程度的肝功能损伤,Chen等[5]通过对99例患者的研究发现,超过40%的COVID-19患者在病程中出现不同程度肝功能损伤。     

新型冠状病毒肺炎合并心血管基础疾病的临床特点及心肌损伤的病理生理机制

新型冠状病毒肺炎(COVID-19)自暴发以来,已造成全球大流行。其心血管损伤的临床表现主要包括心律失常、心原性休克和急性心肌损伤等。而合并心血管基础疾病的COVID-19患者疾病进展更迅速,死亡率更高。本文对细胞因子风暴和血管紧张素转换酶2表达失衡导致心脏损伤进行文献复习,希望对制定临床对策有一定的启示作用。     

新型冠状病毒肺炎患者心血管损伤机制研究进展

2019新型冠状病毒(2019-nCoV)是引起新型冠状病毒肺炎(COVID-19)大爆发的病毒,其通过病毒表面棘突蛋白与血管紧张素转换酶2受体结合而感染细胞,导致内皮细胞损伤,引起"炎症因子风暴",造成凝血功能障碍,甚至导致死亡。随着对COVID-19发病机制研究的深入,COVID-19逐渐被视为一种血管性疾病,现主要就COVID-19患者心血管损伤的可能机制做一综述。     

导读

正免疫炎症反应对高血压合并新型冠状病毒肺炎的影响(陈纪烨,等p10)新型冠状病毒肺炎(coronavirus disease2019,COVID-19)的全球性大流行是当前人类健康的重大挑战,而合并高血压成为COVID-19死亡的高危人群。研究该人群病情恶化的可能机制对于降低疾病死亡率有重要的意义。陈纪烨等综述了近一年来在COVID-19合并高血压人群的免疫炎症反应的重要研究成果,分析了免疫功能失调和炎症反应过度对不良预后的影响及其机制,对于深化COVID-19病理生理学认识具有重要的价值。     

新型冠状病毒病（COVID-19）并发心肌损伤的研究现状

新型冠状病毒病（coronavirus disease 2019,COVID-19）是由急性呼吸综合征新型冠状病毒（SARS-CoV-2）引起的一种感染性极强的严重呼吸系统综合征,目前已形成世界性大爆发,给人类健康和全球经济带来了极大的影响。现有研究表明,COVID-19除了影响呼吸系统外,还对心血管系统有侵害作用,引起心肌损伤,预后较差。本文就现有的COVID-19并发心肌损伤的病原学、潜在的发病机制、相关临床表现特征、治疗原则及预后等方面研究进行论述,旨在加深临床医师对COVID-19并发心肌损伤的认识。     

Role of Cardiac Biomarkers in COVID-19: What Recent Investigations Tell Us?

Purpose of review: Although the respiratory system is the main target of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), it is evident from recent data that other systems, especially cardiovascular and hematological, are also significantly affected. In fact, in severe form, COVID-19 causes a systemic illness with widespread inflammation and cytokine flood, resulting in severe cardiovascular injury. Therefore, we reviewed cardiac injury biomarkers' role in various cardiovascular complications of COVID 19 in recent studies. Recent findings: Cardiac injury biomarkers were elevated in most of the complicated cases of COVID-19, and their elevation is directly proportional to the worst outcome. Evaluation of cardiac biomarkers with markers of other organ damage gives a more reliable tool for case fatalities and future outcome. Summary: Significant association of cardiac biomarkers in COVID-19 cases helps disease management and prognosis, especially in severely ill patients.     

Cardiovascular Implications of the COVID-19 Pandemic: A Global Perspective

The coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), represents the pandemic of the century, with approximately 3.5 million cases and 250,000 deaths worldwide as of May 2020. Although respiratory symptoms usually dominate the clinical presentation, COVID-19 is now known to also have potentially serious cardiovascular consequences, including myocardial injury, myocarditis, acute coronary syndromes, pulmonary embolism, stroke, arrhythmias, heart failure, and cardiogenic shock. The cardiac manifestations of COVID-19 might be related to the adrenergic drive, systemic inflammatory milieu and cytokine-release syndrome caused by SARS-CoV-2, direct viral infection of myocardial and endothelial cells, hypoxia due to respiratory failure, electrolytic imbalances, fluid overload, and side effects of certain COVID-19 medications. COVID-19 has profoundly reshaped usual care of both ambulatory and acute cardiac patients, by leading to the cancellation of elective procedures and by reducing the efficiency of existing pathways of urgent care, respectively. Decreased use of health care services for acute conditions by non-COVID-19 patients has also been reported and attributed to concerns about acquiring in-hospital infection. Innovative approaches that leverage modern technologies to tackle the COVID-19 pandemic have been introduced, which include telemedicine, dissemination of educational material over social media, smartphone apps for case tracking, and artificial intelligence for pandemic modelling, among others. This article provides a comprehensive overview of the pathophysiology and cardiovascular implications of COVID-19, its impact on existing pathways of care, the role of modern technologies to tackle the pandemic, and a proposal of novel management algorithms for the most common acute cardiac conditions.     

Differences in clinical characteristics and liver injury between suspected and confirmed COVID-19 patients in Jingzhou,Hubei Province of China

To evaluate the clinical characteristics and liver injury in coronavirus disease 2019 (COVID-19) patients, and analyze the differences between suspected and confirmed COVID-19 patients, this retrospective study was performed on 157 COVID-19 patients and 93 suspected patients who were ultimately excluded from COVID-19 (control patients). Differences in clinical characteristics and liver injury between suspected and confirmed COVID-19 patients were analyzed. Age, male sex, fever, chest tightness and dyspnea were related to the severity of COVID-19. C-reactive protein (CRP) and D-dimer may be predictors of the severity of COVID-19. Computed tomography (CT) played an important role in the screening of COVID-19 and the evaluation of disease severity. Multiple factors may cause liver injury in COVID-19 patients. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may be more likely to cause liver injury than common respiratory infectious diseases. Age, temperature (T), white blood cell (WBC), lymphocytes (LY), hematocrit (HCT), CRP, and finger pulse oxygen saturation (SpO₂₎ may correlate with liver function impairment and may predict the occurrence and severity of liver function impairment. Some therapeutic drugs (like glucocorticoid) may be involved in the liver function impairment of COVID-19 patients. Most liver function indices improved significantly after active treatment. Although COVID-19 and other common respiratory infectious diseases share some clinical characteristics, COVID-19 has its own characteristics.     

新型冠状病毒肺炎心血管并发症研究现状

新型冠状病毒肺炎是由严重急性呼吸综合征冠状病毒2引起的一种传染性疾病,目前的临床证据表明,新型冠状病毒肺炎合并基础心血管系统疾病的患者死亡风险明显增加,大部分患者在病程中会发生心肌炎、心肌损伤、心律失常和心肌病等。该文主要阐述新型冠状病毒肺炎心血管并发症的研究现状。     

Liver diseases in COVID-19:Etiology,treatment and prognosis

In December 2019, a novel coronavirus named severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) was identified in Wuhan, China causing coronavirus disease-2019(COVID-19). Numerous studies have shown varying degrees of liver damage in patients infected with SARS-CoV-2. However, in previous case studies of COVID-19, the exact cause of liver injury has not been clearly elucidated, nor is there clear evidence of the interaction between liver injury and COVID-19. This study will analyze the causes of liver injury in COVID-19 and the influence of liver-related complications on the treatment and prognosis of COVID-19.     

COVID-19 and liver injury: An ongoing challenge

The new coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified in December 2019, in Wuhan, China. The virus was rapidly spread worldwide, causing coronavirus disease 2019 (COVID-19) pandemic. Although COVID-19 is presented, usually, with typical respiratory symptoms (i.e., dyspnea, cough) and fever, extrapulmonary manifestations are also encountered. Liver injury is a common feature in patients with COVID-19 and ranges from mild and temporary elevation of liver enzymes to severe liver injury and, even, acute liver failure. The pathogenesis of liver damage is not clearly defined; multiple mechanisms contribute to liver disorder, including direct cytopathic viral effect, cytokine storm and immune-mediated hepatitis, hypoxic injury, and drug-induced liver toxicity. Patients with underlying chronic liver disease (i.e., cirrhosis, non-alcoholic fatty liver disease, alcohol-related liver disease, hepatocellular carcinoma, etc.) may have greater risk to develop both severe COVID-19 and further liver deterioration, and, as a consequence, certain issues should be considered during disease management. The aim of this review is to present the prevalence, clinical manifestation and pathophysiological mechanisms of liver injury in patients with SARS-CoV-2 infection. Moreover, we overview the association between chronic liver disease and SARS-CoV-2 infection and we briefly discuss the management of liver injury during COVID-19.     

Heart and Lung Multimodality Imaging in COVID-19

The severe acute respiratory syndrome-coronavirus-2 outbreak has rapidly reached pandemic proportions and has become a major threat to global health. Although the predominant clinical feature of coronavirus disease-2019 (COVID-19) is an acute respiratory syndrome of varying severity, ranging from mild symptomatic interstitial pneumonia to acute respiratory distress syndrome, the cardiovascular system can be involved in several ways. As many as 40% of patients hospitalized with COVID-19 have histories of cardiovascular disease, and current estimates report a proportion of myocardial injury in patients with COVID-19 of up to 12%. Multiple pathways have been suggested to explain this finding and the related clinical scenarios, encompassing local and systemic inflammatory responses and oxygen supply-demand imbalance. From a clinical point of view, cardiac involvement during COVID-19 may present a wide spectrum of severity, ranging from subclinical myocardial injury to well-defined clinical entities (myocarditis, myocardial infarction, pulmonary embolism, and heart failure), whose incidence and prognostic implications are currently largely unknown because of a significant lack of imaging data. Integrated heart and lung multimodality imaging plays a central role in different clinical settings and is essential in the diagnosis, risk stratification, and management of patients with COVID-19. The aims of this review are to summarize imaging-oriented pathophysiological mechanisms of lung and cardiac involvement in COVID-19 and to provide a guide for integrated imaging assessment in these patients.     

COVID-19 vaccination and liver disease

Various vaccines against severe acute respiratory syndrome coronavirus 2 have been developed in response to the coronavirus disease 2019 (COVID-19) global pandemic, several of which are highly effective in preventing COVID-19 in the general population. Patients with chronic liver diseases (CLDs), particularly those with liver cirrhosis, are considered to be at a high risk for severe COVID-19 and death. Given the increased rates of disease severity and mortality in patients with liver disease, there is an urgent need to understand the efficacy of vaccination in this population. However, the data regarding efficacy and safety of COVID-19 vaccination in patients with CLDs is limited. Indeed, several organ-specific or systemic immune-mediated side effects following COVID-19 vaccination, including liver injury similar to autoimmune hepatitis, have been recently reported. Although the number of cases of vaccine-related liver injury is increasing, its frequency, clinical course, and mechanism remain unclear. Here, we review the current findings on COVID-19 vaccination and liver disease, focusing on: (1) The impact of COVID-19 in patients with CLD; (2) The efficacy, safety, and risk-benefit profiles of COVID-19 vaccines in patients with CLD; and (3) Liver injury following COVID-19 vaccination.     

Challenges in the management of patients with systemic light chain (AL) amyloidosis during the COVID-19 pandemic

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-associated coronavirus disease 2019 (COVID-19) is primarily manifested as a respiratory tract infection, but may affect and cause complications in multiple organ systems (cardiovascular, gastrointestinal, kidneys, haematopoietic and immune systems), while no proven specific therapy exists. The challenges associated with COVID-19 are even greater for patients with light chain (AL) amyloidosis, a rare multisystemic disease affecting the heart, kidneys, liver, gastrointestinal and nervous system. Patients with AL amyloidosis may need to receive chemotherapy, which probably increases infection risk. Management of COVID-19 may be particularly challenging in patients with AL amyloidosis, who often present with cardiac dysfunction, nephrotic syndrome, neuropathy, low blood pressure and gastrointestinal symptoms. In addition, patients with AL amyloidosis may be more susceptible to toxicities of drugs used to manage COVID-19. Access to health care may be difficult or limited, diagnosis of AL amyloidosis may be delayed with detrimental consequences and treatment administration may need modification. Both patients and treating physicians need to adapt in a new reality.