Hassani Amir Hossein, Beheshti Alireza, Almasi Faezeh, Ketabi Moghaddam Pardis, Azizi Mohammadreza, Shahrokh Shabnam
Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Gastroenterol Hepatol Bed Bench. 2020 Fall;13(4):410-414.
As of December 2019, a new strain of coronavirus named severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) was discovered in Wuhan, China, following an epidemic of a fast-spreading viral respiratory disease, later called Coronavirus Disease 2019 (COVID-19), which then lead to the present pandemic the world has come to know. Patients who tested positive for COVID-19 are mostly asymptomatic or present with mild self-limiting symptoms. While GI symptoms occur with less prevalence, they are increasingly being reported. A diagnosis of Covid-19 has increased dramatically in patients presenting with gastrointestinal symptoms suggesting that GI symptoms should be taken into serious consideration with patient diagnosis. A 65-year-old man presented to the hospital emergency room with abdominal pain, Murphy's sign and chills without fever, subsequently diagnosed as acute acalculous cholecystitis with a positive COVID-19 rRT-PCR. A 78-year-old woman presented to the hospital emergency room complaining of severe positional epigastric pain precipitated by lying supine, chills with no fever, being later diagnosed as acute pancreatitis and a positive COVID-19 rRT-PCR. It has become evident that the ACE2 receptor plays a significant role as the entry site into human cells for the virus. This receptor is generally expressed in respiratory cells, as well as the gastrointestinal tract, corresponding with extrapulmonary manifestations of COVID-19. Studies concluded that the origin of gastrointestinal symptoms could be caused by the interaction of the SARS-CoV-2 virus with cells through the ACE2 receptor. The findings of the present study support this theory, as both patients presented with symptoms regarding tissues with high ACE2 expression.
截至2019年12月，在中国武汉发现了一种名为严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的新型冠状病毒，此前出现了一种快速传播的病毒性呼吸道疾病疫情，后来被称为2019冠状病毒病（COVID-19），随后导致了目前全球所知的大流行。COVID-19检测呈阳性的患者大多无症状或表现为轻度自限性症状。虽然胃肠道症状的发生率较低，但报告越来越多。出现胃肠道症状的患者中COVID-19的诊断显著增加，这表明在患者诊断中应认真考虑胃肠道症状。一名65岁男性因腹痛、墨菲氏征和寒战但无发热到医院急诊室就诊，随后被诊断为急性非结石性胆囊炎，COVID-19逆转录实时聚合酶链反应（rRT-PCR）呈阳性。一名78岁女性因仰卧时出现严重的上腹部定位性疼痛、寒战但无发热到医院急诊室就诊，后来被诊断为急性胰腺炎，COVID-19 rRT-PCR呈阳性。显然，血管紧张素转换酶2（ACE2）受体作为病毒进入人体细胞的入口位点发挥着重要作用。该受体通常在呼吸道细胞以及胃肠道中表达，这与COVID-19的肺外表现相对应。研究得出结论，胃肠道症状的起源可能是SARS-CoV-2病毒通过ACE2受体与细胞相互作用所致。本研究的结果支持这一理论, 因为两名患者均表现出与ACE2高表达组织有关的症状。
