Dratcu Luiz, Boland Xavier
Psychiatry, South London and Maudsley NHS Foundation Trust, London, GBR.
Cureus. 2020 Oct 28;12(10):e11220. doi: 10.7759/cureus.11220.
COVID-19 has a benign outcome in most cases, yet it can also be fatal and no specific treatment is available as of yet. Older age and several medical comorbidities are risk factors for COVID-19 complications. We report on an elderly man with a longstanding history of bipolar affective disorder associated with heavy smoking, alcohol abuse and multiple comorbidities, including severe chronic obstructive pulmonary disease and recurrent pulmonary sepsis, who contracted COVID-19 during his inpatient treatment of a manic episode, and who fully recovered from COVID-19 without any need for respiratory support. We discuss how his excessive use of nicotine replacement therapy may have contributed to his emerging unscathed from COVID-19. Nicotine, an α7-nACh receptor agonist, may boost the cholinergic anti-inflammatory pathway and hinder the uncontrolled overproduction of pro-inflammatory cytokines triggered by the SARS-CoV-2 virus, which is understood to be the main pathway to poor outcomes and death in severe COVID-19.
在大多数情况下，新冠病毒病（COVID-19）的预后良好，但它也可能是致命的，而且目前尚无特效治疗方法。高龄和多种合并症是COVID-19并发症的危险因素。我们报告了一名老年男性，他有长期的双相情感障碍病史，伴有大量吸烟、酗酒和多种合并症，包括严重的慢性阻塞性肺疾病和复发性肺脓毒症。他在因躁狂发作住院治疗期间感染了COVID-19，但完全康复，无需呼吸支持。我们讨论了他过度使用尼古丁替代疗法可能是他在感染COVID-19后安然无恙的原因。尼古丁是一种α7烟碱型乙酰胆碱受体激动剂，可能会增强胆碱能抗炎途径，并抑制由严重急性呼吸综合征冠状病毒2（SARS-CoV-2）病毒引发的促炎细胞因子的失控过度产生，而这被认为是重症COVID-19患者预后不良和死亡的主要途径。
