Yuksel Aycan, Karadogan Dilek, Gurkan Canan Gunduz, Akyil Fatma Tokgoz, Toreyin Zehra Nur, Marim Feride, Arikan Huseyin, Eyuboglu Tugba Sismanlar, Emiralioglu Nagehan, Serifoglu Irem, Develi Elif, Celik Selman, Sertcelik Umran Ozden, Gursoy Tugba Ramasli, Elversli Mehmet Fatih, Oncel Asli, Er Berrin, Firincioglulari Ali, Gunaydin Fatma Esra, Ozakinci Hilal, Ozcelik Neslihan, Esendagli Dorina, Aydin Asena, Kose Neslihan, Ercelik Merve, Gulhan Pinar Yildiz, Yildiz Ethem, Irmak Ilim, Kara Bilge Yilmaz, Gurz Selcuk, Karakas Fatma Gulsum, Akgun Metin
Department of Chest Diseases, Ufuk University School of Medicine, Ankara, Turkey.
Department of Chest Diseases, Recep Tayyip Erdogan University School of Medicine, Rize, Turkey.
Eurasian J Med. 2020 Jun;52(2):191-196. doi: 10.5152/eurasianjmed.2020.20092.
Scientists from all over the world have been intensively working to discover different aspects of Coronavirus disease 2019 (COVID-19) since the first cluster of cases was reported in China. Herein, we aimed to investigate unclear issues related to transmission and pathogenesis of disease as well as accuracy of diagnostic tests and treatment modalities. A literature search on PubMed, Ovid, and EMBASE databases was conducted, and articles pertinent to identified search terms were extracted. A snow-ball search strategy was followed in order to retrieve additional relevant articles. It was reported that viral spread may occur during the asymptomatic phase of infection, and viral load was suggested to be a useful marker to assess disease severity. In contrast to immune response against viral infections, cytotoxic T lymphocytes decline in SARS-CoV-2 infection, which can be partially explained by direct invasion of T lymphocytes or apoptosis activated by SARS-CoV-2. Dysregulation of the urokinase pathway, cleavage of the SARS-CoV-2 Spike protein by FXa and FIIa, and consumption coagulopathy were the proposed mechanisms of the coagulation dysfunction in COVID-19. False-negative rates of reverse transcriptase polymerase chain reaction varied between 3% and 41% across studies. The probability of the positive test was proposed to decrease with the number of days past from symptom onset. Safety issues related to infection spread limit the use of high flow nasal oxygen (HFNO) and continuous positive airway pressure (CPAP) in hypoxic patients. Further studies are required to elucidate the challenging issues, thus enhancing the management of COVID-19 patients.
自中国报告首例新冠病毒肺炎（COVID-19）病例群以来，来自世界各地的科学家一直在深入研究COVID-19的不同方面。在此，我们旨在调查与疾病传播、发病机制以及诊断测试和治疗方式准确性相关的不明问题。我们在PubMed、Ovid和EMBASE数据库中进行了文献检索，并提取了与确定的检索词相关的文章。为了检索更多相关文章，我们采用了滚雪球式检索策略。据报道，病毒传播可能发生在感染的无症状阶段，病毒载量被认为是评估疾病严重程度的有用标志物。与针对病毒感染的免疫反应不同，在严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染中细胞毒性T淋巴细胞数量减少，这可以部分解释为T淋巴细胞的直接侵袭或SARS-CoV-2激活的细胞凋亡。尿激酶途径失调、凝血因子Xa（FXa）和凝血因子II（FIIa）对SARS-CoV-2刺突蛋白的切割以及消耗性凝血病是COVID-19凝血功能障碍的潜在机制。在各项研究中，逆转录聚合酶链反应的假阴性率在3%至41%之间。据推测，随着症状出现天数的增加，检测呈阳性的概率会降低。与感染传播相关的安全问题限制了在低氧患者中使用高流量鼻导管给氧（HFNO）和持续气道正压通气（CPAP）。需要进一步研究来阐明这些具有挑战性的问题，从而加强对COVID-19患者的管理。
