Mirbeyk Mona, Saghazadeh Amene, Rezaei Nima
Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
Systematic Review and Meta-analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
Adv Exp Med Biol. 2021;1318:209-222. doi: 10.1007/978-3-030-63761-3_13.
Since December 2019, a novel coronavirus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has begun to infect people. The virus first occurred in Wuhan, China, but the whole world is now struggling with the pandemic. Over 13 million confirmed cases and 571,000 deaths have been reported so far, and this number is growing. Older people, who constitute a notable proportion of the world population, are at an increased risk of infection because of altered immunity and chronic comorbidities. Thus, appropriate health care is necessary to control fatalities and spread of the disease in this specific population. The chapter provides an overview of diagnostic methods, laboratory and imaging findings, clinical features, and management of COVID-19 in aged people. Possible mechanisms behind the behavior of SARS-CoV-2 in the elderly include immunosenescence and related impaired antiviral immunity, mature immunity and related hyper-inflammatory responses, comorbidities and their effects on the functioning of critical organs/systems, and the altered expression of angiotensin-converting enzyme 2 (ACE2) that acts as an entry receptor for SARS-CoV-2. This evidence defines the herding behavior of COVID-19 in relation to ACE2 under the influence of immune dysregulation. Then, identifying the immunogenetic factors that affect the disease susceptibility and severity and as well as key inflammatory pathways that have the potential to serve as therapeutic targets needs to remain an active area of research.
自2019年12月以来,一种名为严重急性呼吸综合征冠状病毒2(SARS-CoV-2)的新型冠状病毒开始感染人类。该病毒最初在中国武汉出现,但现在全世界都在与这场大流行作斗争。截至目前,已报告超过1300万例确诊病例和57.1万例死亡,且这一数字还在不断增长。老年人占世界人口的相当比例,由于免疫力改变和慢性合并症,他们的感染风险增加。因此,需要适当的医疗保健来控制这一特定人群中疾病的死亡率和传播。本章概述了老年人新型冠状病毒肺炎(COVID-19)的诊断方法、实验室和影像学检查结果、临床特征及管理。SARS-CoV-2在老年人中表现的可能机制包括免疫衰老及相关抗病毒免疫受损、成熟免疫及相关的过度炎症反应、合并症及其对重要器官/系统功能的影响,以及作为SARS-CoV-2进入受体的血管紧张素转换酶2(ACE2)表达的改变。这一证据确定了在免疫失调影响下COVID-19与ACE2相关的聚集行为。那么,确定影响疾病易感性和严重程度的免疫遗传因素以及有可能作为治疗靶点的关键炎症途径仍将是一个活跃的研究领域。