Sommer Natascha, Schmeck Bernd
Excellence Cluster Cardio-Pulmonary Institute (CPI), Universities of Giessen and Marburg Lung Center (UGMLC), Justus-Liebig-Universität, Klinikstr. 33, 35390, Gießen, Deutschland.
Klinik für Innere Medizin mit Schwerpunkt Pneumologie, Schlaf- und Intensivmedizin, Sektion für Atemwegsinfektionen, Philipps-Universität Marburg, Marburg, Deutschland.
Inn Med (Heidelb). 2022 Aug;63(8):819-829. doi: 10.1007/s00108-022-01371-3. Epub 2022 Jul 7.
Pulmonary manifestations are very common sequelae after severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infections, which are summarized under the term long COVID (coronavirus disease) syndrome.
AIM/METHODS: This article summarizes the current literature on pulmonary manifestations with a focus on expert opinions and recommendations.
After chronic fatigue, dyspnea is the most common symptom in patients with long COVID syndrome. Pathological findings are mainly found after a severe acute course of COVID-19 and include radiological changes with characteristics of interstitial lung diseases, restrictive ventilation patterns and limitations in diffusion capacity as the most common pathological finding. Although both symptoms and pathological pulmonary alterations improve over time, some patients may still suffer from abnormalities months after the acute infection. The relevance of the pathological findings, as well as the involvement of functional respiratory limitations, cardiopulmonary deconditioning, non-somatic causes and pre-existing lung diseases, is currently unclear. The advanced diagnostic assessment thus focusses on high-risk patients and includes, in addition to imaging and pulmonary function tests, a cardiopulmonary exercise test and, if the findings are unclear, an echocardiography to diagnose a pulmonary vascular component. The therapeutic options currently include treatment of the underlying causes of the symptoms (e.g. interstitial lung diseases, cough) according to the respective guidelines and rehabilitation measures.
The current knowledge about pulmonary manifestations in long COVID patients is constantly being expanded, but due to limited availability of clinical trials, there are still no evidence-based guidelines for the diagnosis and therapy of pulmonary manifestations in long COVID syndrome.
肺部表现是严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）感染后非常常见的后遗症，这些后遗症被归纳在长期新冠（冠状病毒病）综合征这一术语之下。
目的/方法：本文总结了关于肺部表现的当前文献，重点关注专家意见和建议。
在慢性疲劳之后，呼吸困难是长期新冠综合征患者最常见的症状。病理结果主要出现在新冠病毒病的严重急性病程之后，包括具有间质性肺疾病特征的放射学改变、限制性通气模式以及弥散能力受限，这是最常见的病理表现。尽管症状和肺部病理改变会随着时间改善，但一些患者在急性感染数月后可能仍存在异常。目前尚不清楚病理结果的相关性，以及功能性呼吸受限、心肺功能减退、非躯体性原因和既往肺部疾病的影响。因此，高级诊断评估主要针对高危患者，除了影像学和肺功能测试外，还包括心肺运动试验，如果结果不明确，则进行超声心动图检查以诊断肺血管病变。目前的治疗选择包括根据各自的指南治疗症状的潜在病因（如间质性肺疾病、咳嗽）以及康复措施。
目前关于长期新冠患者肺部表现的知识在不断扩展，但由于临床试验的可及性有限，对于长期新冠综合征肺部表现的诊断和治疗仍没有基于证据的指南。
