Ludwig Boltzmann Institute for Experimental and Clinical Traumatology in the AUVA Research Center, Vienna, Austria.
Department of Anaesthesiology, University of Göttingen Medical Center, Göttingen, Georg-August University of Göttingen, Göttingen, Germany.
Lancet Respir Med. 2021 Jun;9(6):622-642. doi: 10.1016/S2213-2600(21)00218-6. Epub 2021 May 6.
The zoonotic SARS-CoV-2 virus that causes COVID-19 continues to spread worldwide, with devastating consequences. While the medical community has gained insight into the epidemiology of COVID-19, important questions remain about the clinical complexities and underlying mechanisms of disease phenotypes. Severe COVID-19 most commonly involves respiratory manifestations, although other systems are also affected, and acute disease is often followed by protracted complications. Such complex manifestations suggest that SARS-CoV-2 dysregulates the host response, triggering wide-ranging immuno-inflammatory, thrombotic, and parenchymal derangements. We review the intricacies of COVID-19 pathophysiology, its various phenotypes, and the anti-SARS-CoV-2 host response at the humoral and cellular levels. Some similarities exist between COVID-19 and respiratory failure of other origins, but evidence for many distinctive mechanistic features indicates that COVID-19 constitutes a new disease entity, with emerging data suggesting involvement of an endotheliopathy-centred pathophysiology. Further research, combining basic and clinical studies, is needed to advance understanding of pathophysiological mechanisms and to characterise immuno-inflammatory derangements across the range of phenotypes to enable optimum care for patients with COVID-19.
导致 COVID-19 的人畜共患 SARS-CoV-2 病毒继续在全球范围内传播，造成了毁灭性的后果。虽然医学界已经深入了解 COVID-19 的流行病学，但对于疾病表型的临床复杂性和潜在机制仍存在重要问题。COVID-19 最常见的严重表现涉及呼吸系统，但其他系统也受到影响，急性疾病通常会伴随长期并发症。如此复杂的表现表明，SARS-CoV-2 会使宿主反应失调，引发广泛的免疫炎症、血栓形成和实质紊乱。我们回顾了 COVID-19 病理生理学的复杂性、其各种表型以及体液和细胞水平上的抗 SARS-CoV-2 宿主反应。COVID-19 与其他来源的呼吸衰竭之间存在一些相似之处，但许多独特的机制特征的证据表明 COVID-19 构成了一种新的疾病实体，新出现的数据表明涉及以血管内皮病变为中心的病理生理学。需要进一步结合基础和临床研究来推进对病理生理机制的理解，并对各种表型的免疫炎症紊乱进行特征描述，从而为 COVID-19 患者提供最佳护理。
