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2019冠状病毒病对肠道的影响:临床表现、病理学、管理及挑战综述

Impact of COVID-19 on the Gut: A Review of the Manifestations, Pathology, Management, and Challenges.

作者信息

Suryana Kresna Dharma, Simadibrata Marcellus, Renaldi Kaka

机构信息

Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/ Dr. Cipto Mangunkusumo General Hospital National Hospital, Jakarta.

出版信息

Acta Med Indones. 2021 Jan;53(1):96-104.

Abstract

SARS-CoV-2 is a virus that can enter its hosts through the Angiotensin Converting Enzyme-2 (ACE2) receptor. ACE2 is mainly expressed in cells of the gastrointestinal tract, such as the esophageal epithelium and enterocytes from the ileum-colon. Coronavirus Disease 2019 (COVID-19) has varying clinical symptoms and presents differently in individuals, ranging from asymptomatic carriers to moderate clinical spectrum with mild pneumonia clinical features, and to a severe clinical presentation with dyspnea and hypoxia, leading to death due to respiratory or multi-organ failure. COVID-19 infection can also manifest themselves in the form of gastrointestinal symptoms such as diarrhea, vomiting, nausea, and abdominal pain. Severe complications of gastrointestinal COVID-19 infections include hemorrhage or perforation of the gastrointestinal tract and severe inflammation, which can adversely affect the intestinal immune system, and therefore the systemic immune system of the host. Furthermore, COVID-19 has also shown to affect microbiota homeostasis in the digestive tract. To date, no clear explanation is available regarding the pathophysiology of gastrointestinal SARS-CoV-2 infection, fecal RNA detection, and the possibility of fecal-oral transmission of SARS-CoV-2. This review aims to discuss the effects of SARS-CoV-2 infection on the digestive tract, microbiota, and lung, and the possibility of fecal-oral transmission in COVID-19.

摘要

严重急性呼吸综合征冠状病毒2(SARS-CoV-2)是一种可通过血管紧张素转换酶2(ACE2)受体进入宿主的病毒。ACE2主要在胃肠道细胞中表达,如食管上皮细胞和回肠-结肠的肠上皮细胞。2019冠状病毒病(COVID-19)具有不同的临床症状,在个体中表现各异,从无症状携带者到具有轻度肺炎临床特征的中度临床症状,再到伴有呼吸困难和低氧血症的严重临床表现,最终因呼吸或多器官衰竭而死亡。COVID-19感染也可表现为腹泻、呕吐、恶心和腹痛等胃肠道症状。胃肠道COVID-19感染的严重并发症包括胃肠道出血或穿孔以及严重炎症,这会对肠道免疫系统产生不利影响,进而影响宿主的全身免疫系统。此外,COVID-19还显示会影响消化道中的微生物群稳态。迄今为止,关于胃肠道SARS-CoV-2感染的病理生理学、粪便RNA检测以及SARS-CoV-2粪口传播的可能性尚无明确解释。本综述旨在探讨SARS-CoV-2感染对消化道、微生物群和肺部的影响以及COVID-19中粪口传播的可能性。

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