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[心血管疾病与2019冠状病毒病:病理生理学、并发症及治疗]

[Cardiovascular diseases and COVID-19 : Pathophysiology, complications and treatment].

作者信息

Schieffer Elisabeth, Schieffer Bernhard, Hilfiker-Kleiner Denise

机构信息

Institut für Sportmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland.

Klinik für Kardiologie, Angiologie and Intensivmedizin, Philips-Universität Marburg, Marburg, Deutschland.

出版信息

Herz. 2021 Mar;46(2):107-114. doi: 10.1007/s00059-020-05013-y. Epub 2021 Jan 4.

Abstract

The coronavirus disease 2019 (COVID-19) pandemic is a challenge for our healthcare system but at the same time is one of the excellent catalyzers and promoters of successful translational research. The COVID-19 is not only a simple viral infection of the bronchial system but is also a pandemic hyperinflammatory multiorgan disease. The cardiovascular system plays a causal role in this context, as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) invades host cells via the angiotensin-converting enzyme 2 (ACE-2), an enzyme in the renin-angiotensin system. Furthermore, cardiovascular comorbidities and risk factors, such as hypertension, diabetes and obesity play an important role in the severity of the course of the disease. Additional risk factors, such as gender, age, genetics and air pollution modulate both the severity of the SARS-CoV‑2 infection as well as cardiovascular diseases. As sequelae of COVID-19, increased thrombosis, myocardial infarction, myocardial inflammation and vasculitis occur, which directly damage the cardiovascular system and substantially contribute to the high morbidity and mortality. Knowledge gained from many studies on the course of the disease in patients infected with SARS-CoV‑2 has led to improved treatment possibilities, which now in the second wave are partly standardized and were, and are, in particular adapted to complications of the cardiovascular system. In this review we provide a short overview on the pathophysiology of the SARS-CoV‑2 in general and also specifically on the cardiovascular system. Furthermore, we summarize the current treatment approaches and their pathophysiological principles (status November 2020).

摘要

2019年冠状病毒病(COVID-19)大流行对我们的医疗系统构成了挑战,但与此同时,它也是成功的转化研究的优秀催化剂和推动者之一。COVID-19不仅是支气管系统的简单病毒感染,也是一种大流行的高炎症性多器官疾病。在这种情况下,心血管系统起着因果作用,因为严重急性呼吸综合征冠状病毒2(SARS-CoV-2)通过肾素-血管紧张素系统中的一种酶——血管紧张素转换酶2(ACE-2)侵入宿主细胞。此外,心血管合并症和危险因素,如高血压、糖尿病和肥胖,在疾病病程的严重程度中起着重要作用。其他危险因素,如性别、年龄、遗传和空气污染,既调节SARS-CoV-2感染的严重程度,也调节心血管疾病。作为COVID-19的后遗症,血栓形成增加、心肌梗死、心肌炎症和血管炎发生,这些直接损害心血管系统,并在很大程度上导致高发病率和高死亡率。从许多关于感染SARS-CoV-2患者疾病病程的研究中获得的知识带来了更好的治疗可能性,现在在第二波疫情中,部分治疗方法已经标准化,并且过去和现在都特别适用于心血管系统的并发症。在这篇综述中,我们简要概述了SARS-CoV-2的一般病理生理学,特别是心血管系统的病理生理学。此外,我们总结了当前的治疗方法及其病理生理原则(2020年11月情况)。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c1a1/7966227/01f5848f9772/59_2020_5013_Fig1_HTML.jpg

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