Mohammadi Asma, Balan Irina, Yadav Shikha, Matos Wanessa F, Kharawala Amrin, Gaddam Mrunanjali, Sarabia Noemi, Koneru Sri Charitha, Suddapalli Siva K, Marzban Sima
Public Health, University of Nebraska Medical Center, Omaha, USA.
Research and Academic Affairs, Larkin Community Hospital, Miami, USA.
Cureus. 2022 Mar 2;14(3):e22770. doi: 10.7759/cureus.22770. eCollection 2022 Mar.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected millions worldwide with a high mortality rate due to a lack of definitive treatment. Despite having a wide range of clinical features, acute respiratory distress syndrome (ARDS) has emerged as the primary cause of mortality in these patients. Risk factors and comorbidities like advanced age with limited lung function, pre-existing diabetes, hypertension, cardiovascular diseases, and obesity have increased the risk for severe COVID-19 infection. Rise in inflammatory markers like transforming growth factor β (TGF-β), interleukin-6 (IL-6), and expression of matrix metalloproteinase 1 and 7 (MMP-1, MMP-7), along with collagen deposition at the site of lung injury, results in extensive lung scarring and fibrosis. Anti-fibrotic drugs, such as Pirfenidone and Nintedanib, have emerged as potential treatment options for post-COVID-19 pulmonary fibrosis. A lung transplant might be the only life-saving treatment. Despite the current advances in the management of COVID-19, there is still a considerable knowledge gap in the management of long-term sequelae in such patients, especially concerning pulmonary fibrosis. Follow up on the current clinical trials and research to test the efficacy of various anti-inflammatory drugs is needed to prevent long-term sequelae early mortality in these patients.
严重急性呼吸综合征冠状病毒2(SARS-CoV-2)已在全球感染了数百万人,由于缺乏确切的治疗方法,死亡率很高。尽管有广泛的临床特征,但急性呼吸窘迫综合征(ARDS)已成为这些患者死亡的主要原因。诸如肺功能有限的高龄、既往糖尿病、高血压、心血管疾病和肥胖等风险因素及合并症增加了严重COVID-19感染的风险。转化生长因子β(TGF-β)、白细胞介素-6(IL-6)等炎症标志物水平升高,以及基质金属蛋白酶1和7(MMP-1、MMP-7)的表达,再加上肺损伤部位的胶原蛋白沉积,导致广泛的肺瘢痕形成和纤维化。抗纤维化药物,如吡非尼酮和尼达尼布,已成为COVID-19后肺纤维化的潜在治疗选择。肺移植可能是唯一的救命治疗方法。尽管目前在COVID-19的管理方面取得了进展,但在此类患者的长期后遗症管理方面,尤其是关于肺纤维化,仍存在相当大的知识空白。需要对当前的临床试验和研究进行跟踪,以测试各种抗炎药物的疗效,从而预防这些患者的长期后遗症和早期死亡。