Betjes Michiel G H
Division of Nephrology and Transplantation, Department of Internal Medicine, Erasmus Medical Centre, Rotterdam, Netherlands.
Front Med (Lausanne). 2021 Apr 14;8:675573. doi: 10.3389/fmed.2021.675573. eCollection 2021.
One year after the start of the COVID-19 pandemic it has become clear that some groups of individuals are at particular high risk of a complicated course of infection resulting in high morbidity and mortality. Two specific risk factors are most prominent, old age and the presence of co-morbidity. Recent studies have shown that patients with compromised renal function, especially those treated with renal replacement therapy or having received a kidney transplant are at a much higher risk for severe COVID infection and increased mortality. This may be in part due to the increased prevalence of co-morbid conditions in these patients but specific alterations in their immune system, reflecting premature immunological aging, may be equally important. In this review the different aspects, in particular thymus function and memory T cell expansion, of uremia-associated immunological aging are reviewed with respect to COVID 19 infection. In essence, the decreased generation of naïve T cells may be instrumental in suboptimal anti-viral immune responses while the relatively uncontrolled expansion of effector T cells may facilitate the feared phase of the COVID-19 infection with excessive and live-threatening inflammation of the lung parenchyma.
在新冠疫情爆发一年后，很明显，某些人群面临着感染过程复杂、导致高发病率和高死亡率的特别高风险。两个特定的风险因素最为突出，即老年和存在合并症。最近的研究表明，肾功能受损的患者，尤其是那些接受肾脏替代治疗或接受过肾移植的患者，感染新冠病毒的风险更高，死亡率也更高。这可能部分归因于这些患者中合并症患病率的增加，但他们免疫系统的特定改变，反映出过早的免疫衰老，可能同样重要。在这篇综述中，我们就新冠病毒感染对尿毒症相关免疫衰老的不同方面，特别是胸腺功能和记忆T细胞扩增进行了综述。从本质上讲，幼稚T细胞生成减少可能导致抗病毒免疫反应不佳，而效应T细胞相对不受控制的扩增可能会促使新冠病毒感染进入令人担忧的阶段，即肺实质出现过度且危及生命的炎症。
