Matsuishi Yujiro, Mathis Bryan J, Shimojo Nobutake, Subrina Jesmin, Okubo Nobuko, Inoue Yoshiaki
Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan.
Pediatric Intensive Care Unit, University of Tsukuba Hospital, Tsukuba 305-8571, Japan.
Biomedicines. 2021 Mar 10;9(3):279. doi: 10.3390/biomedicines9030279.
Since December 2019, the SARS-CoV-2 (COVID-19) pandemic has transfixed the medical world. COVID-19 symptoms vary from mild to severe and underlying chronic conditions such as pulmonary/cardiovascular disease and diabetes induce excessive inflammatory responses to COVID-19 and these underlying chronic diseases are mediated by endothelial dysfunction. Acute respiratory distress syndrome (ARDS) is the most common cause of death in COVID-19 patients, but coagulation induced by excessive inflammation, thrombosis, and disseminated intravascular coagulation (DIC) also induce death by multiple-organ dysfunction syndrome. These associations imply that maintaining endothelial integrity is crucial for favorable prognoses with COVID-19 and therapeutic intervention to support this may be beneficial. Here, we summarize the extent of heart injuries, ischemic stroke and hemorrhage, acute kidney injury, and liver injury caused by immune-mediated endothelial dysfunction that result in the phenomenon of multi-organ dysfunction seen in COVID-19 patients. Moreover, the potential therapeutic effect of angiotensin receptor blockers and angiotensin-converting enzyme inhibitors that improve endothelial dysfunction as well as the bradykinin storm are discussed.
自2019年12月以来，严重急性呼吸综合征冠状病毒2（SARS-CoV-2，即新冠病毒）大流行震惊了医学界。新冠病毒感染症状从轻微到严重不等，而诸如肺部/心血管疾病和糖尿病等潜在慢性疾病会引发对新冠病毒的过度炎症反应，且这些潜在慢性疾病是由内皮功能障碍介导的。急性呼吸窘迫综合征（ARDS）是新冠病毒感染患者最常见的死亡原因，但过度炎症引发的凝血、血栓形成和弥散性血管内凝血（DIC）也会因多器官功能障碍综合征导致死亡。这些关联表明，维持内皮完整性对于新冠病毒感染患者获得良好预后至关重要，支持这一点的治疗干预可能有益。在此，我们总结了免疫介导的内皮功能障碍所导致的心脏损伤、缺血性卒中和出血、急性肾损伤及肝损伤的程度，这些内皮功能障碍会导致新冠病毒感染患者出现多器官功能障碍现象。此外，还讨论了血管紧张素受体阻滞剂和血管紧张素转换酶抑制剂改善内皮功能障碍以及缓激肽风暴的潜在治疗效果。
