Brandão Simone Cristina Soares, Godoi Emmanuelle Tenório Albuquerque Madruga, Ramos Júlia de Oliveira Xavier, de Melo Leila Maria Magalhães Pessoa, Sarinho Emanuel Sávio Cavalcanti
Universidade Federal de Pernambuco - UFPE, Recife, PE, Brasil.
Serviço de Hematologia de São José dos Campos, São José dos Campos, SP, Brasil.
J Vasc Bras. 2020 Nov 16;19:e20200131. doi: 10.1590/1677-5449.200131.
SARS-CoV-2 is responsible for the COVID-19 pandemic. The immune system is a determinant factor in defense against viral infections. Thus, when it acts in a balanced and effective manner the disease is self-limited and benign. Nevertheless, in a significant proportion of the population, the immune response is exaggerated. When infected, patients with diabetes, hypertension, obesity, and cardiovascular disease are more likely to progress to severe forms. These diseases are related to chronic inflammation and endothelial dysfunction. Toll-like receptors are expressed on immune cells and play an important role in the physiopathology of cardiovascular and metabolic diseases. When activated, they can induce release of inflammatory cytokines. Hypercoagulability, hyperinflammation, platelet hyperresponsiveness, and endothelial dysfunction occur in immune system hyperactivity caused by viral activity, thereby increasing the risk of arterial and venous thrombosis. We discuss the interactions between COVID-19, immunity, the endothelium, and coagulation, as well as why cardiometabolic diseases have a negative impact on COVID-19 prognosis.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）是导致新型冠状病毒肺炎（COVID-19）大流行的病原体。免疫系统是抵御病毒感染的决定性因素。因此，当免疫系统以平衡且有效的方式发挥作用时，疾病具有自限性且为良性。然而，在相当一部分人群中，免疫反应会过度增强。感染时，糖尿病、高血压、肥胖症和心血管疾病患者更易发展为重症。这些疾病与慢性炎症和内皮功能障碍有关。Toll样受体在免疫细胞上表达，在心血管和代谢疾病的病理生理过程中起重要作用。激活后，它们可诱导炎性细胞因子的释放。在病毒活动引起的免疫系统亢进中会出现高凝状态、炎症反应过度、血小板反应性过高及内皮功能障碍，从而增加动脉和静脉血栓形成的风险。我们将探讨COVID-19、免疫、内皮及凝血之间的相互作用，以及为什么心脏代谢疾病会对COVID-19的预后产生负面影响。
