COVID-19 肺外疾病——特殊的胃肠道和肝脏注意事项。
COVID-19 extrapulmonary illness - special gastrointestinal and hepatic considerations.
机构信息
Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Department of Internal Medicine, Texas Tech University, Paul L Foster School of Medicine, El Paso, Texas 79905, USA.
出版信息
Dis Mon. 2020 Sep;66(9):101064. doi: 10.1016/j.disamonth.2020.101064. Epub 2020 Jul 28.
Coronaviruses have caused three global outbreaks in the last 20 years, which include Severe Acute Respiratory Syndrome (SARS) caused by SARS-CoV (SARS-CoV-1), Middle East Respiratory Syndrome (MERS) by MERS-CoV and Coronavirus Disease-2019 (COVID-19) due to SARS-CoV-2. These outbreaks share many similarities, including clinical presentation, transmission, and management. Although respiratory manifestations are responsible for most of the morbidity and mortality in these conditions, extra-pulmonary manifestations such as gastrointestinal symptoms are also increasingly recognized as important symptoms. Important gastrointestinal symptoms include nausea, vomiting, anorexia, diarrhea, and abdominal pain. Hepatic manifestations such as abnormal aminotransferases are also noted in these patients. Early identification of GI symptoms is crucial as some patients can present only with GI manifestations in the absence of pulmonary symptoms. Furthermore, patients with diarrhea have tested positive for viral RNA in the stool. This has been reported even after the resolution of respiratory symptoms and can extend up to many days from the onset of symptoms. Because of this phenomenon, there is a theoretical risk of fecal-oral transmission and the potential spread of the disease. Though GI symptoms are frequently observed, understanding the pathogenesis of these symptoms is crucial, as it can not only of public health importance but could also identify infected patients early in the spread. Understanding the different GI and hepatic manifestations with underlying mechanisms of symptoms can assist in the therapeutic management of these patients. In this article, we summarize various GI and hepatic manifestations with their prevalence, underlying pathophysiology with emphasis on stool positivity.
在过去的 20 年里,冠状病毒已经引发了三次全球疫情爆发,其中包括由 SARS-CoV(SARS-CoV-1)引起的严重急性呼吸综合征(SARS)、由 MERS-CoV 引起的中东呼吸综合征(MERS)和由 SARS-CoV-2 引起的 2019 年冠状病毒病(COVID-19)。这些疫情爆发有许多相似之处,包括临床表现、传播和管理。尽管呼吸道表现是这些疾病中导致大多数发病率和死亡率的原因,但肺部外表现,如胃肠道症状,也被越来越多地认为是重要的症状。重要的胃肠道症状包括恶心、呕吐、厌食、腹泻和腹痛。这些患者还会出现肝酶异常等肝表现。早期识别胃肠道症状至关重要,因为一些患者在没有肺部症状的情况下可能仅表现为胃肠道症状。此外,腹泻患者的粪便中检测到了病毒 RNA。这种情况甚至在呼吸道症状缓解后仍然存在,并且可以从症状出现后持续数天。由于这种现象,存在粪便-口腔传播和疾病传播的理论风险。尽管胃肠道症状经常观察到,但了解这些症状的发病机制至关重要,因为它不仅对公共卫生有重要意义,而且还可以早期识别感染患者。了解胃肠道和肝脏表现的不同表现及其症状的潜在发病机制有助于这些患者的治疗管理。在本文中,我们总结了各种胃肠道和肝脏表现及其流行情况,强调了粪便阳性的潜在病理生理学。
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