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新型冠状病毒肺炎:从急性疾病转为慢性疾病?潜在的长期健康影响。

COVID-19: from an acute to chronic disease? Potential long-term health consequences.

机构信息

Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.

Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Canada.

出版信息

Crit Rev Clin Lab Sci. 2021 Aug;58(5):297-310. doi: 10.1080/10408363.2020.1860895. Epub 2020 Dec 21.

Abstract

Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Despite pulmonary impairments being the most prevalent, extra-pulmonary manifestations of COVID-19 are abundant. Confirmed COVID-19 cases have now surpassed 57.8 million worldwide as of 22 November 2020. With estimated case fatality rates (number of deaths from COVID-19 divided by number of confirmed COVID-19 cases) varying between 1 and 7%, there will be a large population of recovered COVID-19 patients that may acquire a multitude of long-term health consequences. While the multi-organ manifestations of COVID-19 are now well-documented, the potential long-term implications of these manifestations remain to be uncovered. In this review, we turn to previous similar coronaviruses (i.e. SARS-CoV-1 and Middle East respiratory syndrome coronavirus [MERS-CoV]) in combination with known health implications of SARS-CoV-2 infection to predict potential long-term effects of COVID-19, including pulmonary, cardiovascular, hematologic, renal, central nervous system, gastrointestinal, and psychosocial manifestations, in addition to the well-known post-intensive care syndrome. It is necessary to monitor COVID-19 patients after discharge to understand the breadth and severity of long-term effects. This can be accomplished by repurposing or initiating large cohort studies to not only focus on the long-term consequences of SARS-CoV-2 infection, but also on acquired immune function as well as ethno-racial group and household income disparities in COVID-19 cases and hospitalizations. The future for COVID-19 survivors remains uncertain, and if this virus circulates among us for years to come, long-term effects may accumulate exponentially.

摘要

2019 年冠状病毒病(COVID-19)由严重急性呼吸系统综合征冠状病毒 2 型(SARS-CoV-2)引起。尽管肺损伤最为常见,但 COVID-19 的肺外表现也很丰富。截至 2020 年 11 月 22 日,全球已确诊 COVID-19 病例超过 5780 万例。估计 COVID-19 的病死率(COVID-19 死亡人数除以 COVID-19 确诊病例数)在 1%至 7%之间,因此将有大量 COVID-19 康复患者可能会出现多种长期健康后果。虽然 COVID-19 的多器官表现现在已经有了充分的记录,但这些表现的潜在长期影响仍有待揭示。在这篇综述中,我们参考了以前的类似冠状病毒(即 SARS-CoV-1 和中东呼吸综合征冠状病毒[MERS-CoV]),以及 SARS-CoV-2 感染的已知健康影响,来预测 COVID-19 的潜在长期影响,包括肺、心血管、血液、肾脏、中枢神经系统、胃肠道和心理社会表现,以及众所周知的重症监护后综合征。有必要对出院后的 COVID-19 患者进行监测,以了解长期影响的广度和严重程度。这可以通过重新利用或启动大型队列研究来实现,不仅要关注 SARS-CoV-2 感染的长期后果,还要关注获得性免疫功能以及 COVID-19 病例和住院的种族和家庭收入差异。COVID-19 幸存者的未来仍不确定,如果这种病毒在未来几年继续在我们中间传播,长期影响可能会呈指数级增长。

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