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新型冠状病毒肺炎的胃肠道和肝脏表现:全面综述。

Gastrointestinal and hepatic manifestations of COVID-19: A comprehensive review.

机构信息

Department of Internal Medicine, Cleveland Clinic, Akron General, Akron, OH 44307, United States.

Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH 44307, United States.

出版信息

World J Gastroenterol. 2020 May 21;26(19):2323-2332. doi: 10.3748/wjg.v26.i19.2323.

Abstract

The severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) that causes coronavirus disease-2019 (COVID-19) is a global pandemic, manifested by an infectious pneumonia. Although patients primarily present with fever, cough and dyspnea, some patients also develop gastrointestinal (GI) and hepatic manifestations. The most common GI symptoms reported are diarrhea, nausea, vomiting, and abdominal discomfort. Liver chemistry abnormalities are common and include elevation of aspartate transferase, alanine transferase, and total bilirubin. Studies have shown that SARS-CoV-2 infects the GI tract its viral receptor angiotensin converting enzyme II, which is expressed on enterocytes of the ileum and colon. Viral RNA has also been isolated from stool specimens of COVID-19 patients, which raised the concern for fecal-oral transmission in addition to droplet transmission. Although indirect evidence has suggested possible fecal-oral transmission of SARS-CoV-2, more effort is needed to establish the role of the fecal-oral transmission route. Further research will help elucidate the association between patients with underlying GI diseases, such as chronic liver disease and inflammatory bowel disease, and severity of COVID-19. In this review, we summarize the data on GI involvement to date, as well as the impact of COVID-19 on underlying GI diseases.

摘要

导致 2019 年冠状病毒病(COVID-19)的严重急性呼吸综合征冠状病毒 2(SARS-CoV-2)是一种全球性大流行疾病,表现为传染性肺炎。尽管患者主要表现为发热、咳嗽和呼吸困难,但一些患者也会出现胃肠道(GI)和肝脏表现。报告的最常见的胃肠道症状是腹泻、恶心、呕吐和腹部不适。肝功能检查异常很常见,包括天门冬氨酸转移酶、丙氨酸转移酶和总胆红素升高。研究表明,SARS-CoV-2 感染胃肠道-其病毒受体血管紧张素转换酶 2(ACE2),在回肠和结肠的肠上皮细胞中表达。从 COVID-19 患者的粪便标本中也分离出了病毒 RNA,这除了飞沫传播之外,还引发了对粪-口传播的担忧。尽管间接证据表明 SARS-CoV-2 可能存在粪-口传播,但仍需要更多努力来确定粪-口传播途径的作用。进一步的研究将有助于阐明患有潜在胃肠道疾病(如慢性肝病和炎症性肠病)的患者与 COVID-19 严重程度之间的关联。在这篇综述中,我们总结了迄今为止关于胃肠道受累的资料,以及 COVID-19 对潜在胃肠道疾病的影响。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bbfe/7243653/4b14b6d0352a/WJG-26-2323-g001.jpg

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