Cardiovascular Biology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA.
Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, New York, USA.
J Clin Invest. 2022 Aug 1;132(15). doi: 10.1172/JCI161167.
SARS-CoV-2-infected individuals may suffer a multi-organ system disorder known as "long COVID" or post-acute sequelae of SARS-CoV-2 infection (PASC). There are no standard treatments, the pathophysiology is unknown, and incidence varies by clinical phenotype. Acute COVID-19 correlates with biomarkers of systemic inflammation, hypercoagulability, and comorbidities that are less prominent in PASC. Macrovessel thrombosis, a hallmark of acute COVID-19, is less frequent in PASC. Female sex at birth is associated with reduced risk for acute COVID-19 progression, but with increased risk of PASC. Persistent microvascular endotheliopathy associated with cryptic SARS-CoV-2 tissue reservoirs has been implicated in PASC pathology. Autoantibodies, localized inflammation, and reactivation of latent pathogens may also be involved, potentially leading to microvascular thrombosis, as documented in multiple PASC tissues. Diagnostic assays illuminating possible therapeutic targets are discussed.
感染 SARS-CoV-2 的个体可能会遭受一种多器官系统紊乱，称为“长新冠”或 SARS-CoV-2 感染的急性后期后遗症（PASC）。目前尚无标准治疗方法，其病理生理学尚不清楚，且发病率因临床表型而异。急性 COVID-19 与全身性炎症、高凝状态和合并症的生物标志物相关，而这些在 PASC 中并不明显。急性 COVID-19 的标志大血管血栓形成在 PASC 中较少见。出生时为女性与急性 COVID-19 进展风险降低有关，但与 PASC 风险增加有关。与隐匿性 SARS-CoV-2 组织储库相关的持续性微血管内皮病变与 PASC 病理学有关。自身抗体、局部炎症和潜伏病原体的再激活也可能涉及其中，可能导致微血管血栓形成，这在多种 PASC 组织中都有记录。讨论了阐明可能的治疗靶点的诊断检测方法。
