National Clinical Research Center for Child Health, National Children's Regional Medical Center, the Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
College of Medical Technology, Zhejiang Chinese Medical University. Hangzhou, China.
Am J Physiol Gastrointest Liver Physiol. 2020 Aug 1;319(2):G245-G252. doi: 10.1152/ajpgi.00148.2020. Epub 2020 Jul 8.
In addition to the typical respiratory response, new coronavirus disease 2019 (COVID-19) is also associated with very common gastrointestinal symptoms. Cases with gastrointestinal symptoms are more likely to be complicated by liver injury and acute respiratory distress syndrome (ARDS). If not treated in time, coma and circulatory failure may ensue. As severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infects the human body through the combination of angiotensin-converting enzyme 2 (ACE2) in the gastrointestinal tract, the mechanism underlying the gastrointestinal symptoms may involve damage to the intestinal mucosal barrier and promotion of the production of inflammatory factors. Indeed, after cells in the lungs become infected by SARS-CoV-2, effector CD4 T cells reach the small intestine through the gut-lung axis, causing intestinal immune damage and diarrhea; early extensive use of antibacterial and antiviral drugs can also lead to diarrhea in patients. Thus, treatment options for COVID-19 patients should be promptly adjusted when they have gastrointestinal symptoms. As SARS-CoV-2 has been detected in the feces of COVID-19 patients, future prevention and control efforts must consider the possibility of fecal-oral transmission of the virus.
除了典型的呼吸道反应外，新型冠状病毒病 2019（COVID-19）也与非常常见的胃肠道症状有关。有胃肠道症状的病例更有可能并发肝损伤和急性呼吸窘迫综合征（ARDS）。如果不及时治疗，可能会导致昏迷和循环衰竭。由于严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）通过胃肠道中的血管紧张素转换酶 2（ACE2）与人体结合感染，胃肠道症状的机制可能涉及肠黏膜屏障损伤和炎症因子的产生。事实上，当肺部细胞被 SARS-CoV-2 感染后，效应 CD4 T 细胞通过肠-肺轴到达小肠，导致肠道免疫损伤和腹泻；早期广泛使用抗菌和抗病毒药物也会导致患者腹泻。因此，当 COVID-19 患者出现胃肠道症状时，应及时调整治疗方案。由于已经在 COVID-19 患者的粪便中检测到 SARS-CoV-2，未来的预防和控制工作必须考虑到病毒通过粪-口传播的可能性。
