Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.
Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Eur J Clin Invest. 2022 Nov;52(11):e13859. doi: 10.1111/eci.13859. Epub 2022 Sep 1.
Accumulating evidence suggests that endothelial dysfunction is implicated in the pathogenesis and severity of coronavirus disease 2019 (COVID-19). In this context, vascular impairment in COVID-19 might be associated with clinical manifestations and could refine risk stratification in these patients.
This systematic review aims to synthesize current evidence on the frequency and the prognostic value of vascular dysfunction during acute and post-recovery COVID-19. After systematically searching the MEDLINE, clinicaltrials.gov and the Cochrane Library from 1 December 2019 until 05 March 2022, we identified 24 eligible studies with laboratory confirmed COVID-19 and a thorough examination of vascular function. Flow-mediated dilation (FMD) was assessed in 5 and 12 studies in acute and post-recovery phase respectively; pulse wave velocity (PWV) was the marker of interest in three studies in the acute and four studies in the post-recovery phase.
All studies except for one in the acute and in the post-recovery phase showed positive association between vascular dysfunction and COVID-19 infection. Endothelial dysfunction in two studies and increased arterial stiffness in three studies were related to inferior survival in COVID-19.
Overall, a detrimental effect of COVID-19 on markers of endothelial function and arterial stiffness that could persist even for months after the resolution of the infection and provide prognostic value was congruent across published studies. Further research is warranted to elucidate clinical implications of this association.
越来越多的证据表明，内皮功能障碍与 2019 年冠状病毒病（COVID-19）的发病机制和严重程度有关。在这种情况下，COVID-19 中的血管损伤可能与临床表现有关，并可以对这些患者进行更精确的风险分层。
本系统评价旨在综合目前关于 COVID-19 急性期和恢复期血管功能障碍的发生频率和预后价值的证据。从 2019 年 12 月 1 日至 2022 年 3 月 5 日，我们通过系统检索 MEDLINE、clinicaltrials.gov 和 Cochrane 图书馆，确定了 24 项符合条件的研究，这些研究均为实验室确诊的 COVID-19 患者，并对血管功能进行了全面检查。其中 5 项研究和 12 项研究分别在急性期和恢复期评估了血流介导的扩张（FMD）；3 项研究和 4 项研究分别在急性期和恢复期关注脉搏波速度（PWV）。
除了一项在急性期和恢复期的研究外，所有研究都表明血管功能障碍与 COVID-19 感染之间存在正相关。两项研究中的内皮功能障碍和三项研究中的动脉僵硬与 COVID-19 患者的生存率降低有关。
总体而言，发表的研究结果一致表明，COVID-19 对内皮功能和动脉僵硬标志物产生不利影响，即使在感染消退后数月仍持续存在，并具有预后价值。需要进一步研究阐明这种关联的临床意义。
