Makhoul Elias, Aklinski Joseph L, Miller Jesse, Leonard Cara, Backer Sean, Kahar Payal, Parmar Mayur S, Khanna Deepesh
Foundational Sciences, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA.
Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Tampa, USA.
Cureus. 2022 Jul 29;14(7):e27438. doi: 10.7759/cureus.27438. eCollection 2022 Jul.
Although severe cases and mortality of coronavirus disease 2019 (COVID-19) are proportionally infrequent, these cases are strongly linked to patients with conditions of metabolic syndrome (obesity, hypertension, diabetes, and dyslipidemia). However, the pathophysiology of COVID-19 in relation to metabolic syndrome is not well understood. Thus, the goal of this secondary literature review was to examine the relationship between severe acute respiratory syndrome (SARS-CoV-2) infection and the individual conditions of metabolic syndrome. The objective of this secondary literature review was achieved by examining primary studies, case studies, and other secondary studies, to obtain a comprehensive perspective of theories and observations of COVID-19 etiology with metabolic syndrome. The most extensive research was available on the topics of diabetes, hypertension, and obesity, which yielded multiple (and sometimes conflicting) hypothetical pathophysiology. The sources on dyslipidemia and COVID-19 were scarcer and failed to provide an equally comprehensive image, highlighting the need for further research. It was concluded that hypertension had the strongest correlation with COVID-19 incidence (followed by obesity), yet the causative pathophysiology was ambiguous; most likely related to cardiovascular, angiotensin-converting enzyme 2 (ACE-2)-related complications from renin-angiotensin-aldosterone system (RAAS) imbalance. Obesity was also positively correlated to the severity of COVID-19 cases and was believed to contribute to mechanical difficulties with respiration, in addition to hypothetical connections with the expression of ACE-2 on abundant adipose tissue. Diabetes was believed to contribute to COVID-19 severity by producing a chronic inflammatory state and interfering with neutrophil and T-cell function. Furthermore, there were indications that COVID-19 may induce acute-onset diabetes and diabetic ketoacidosis. Lastly, dyslipidemia was concluded to potentially facilitate SARS-CoV-2 infection by enhancing lipid rafts and immunosuppressive functions. There were also indications that cholesterol levels may have prognostic indications and that statins may have therapeutic benefits.
尽管2019冠状病毒病（COVID-19）的重症病例和死亡率相对较少，但这些病例与代谢综合征（肥胖、高血压、糖尿病和血脂异常）患者密切相关。然而，COVID-19与代谢综合征相关的病理生理学尚未完全明确。因此，本次二次文献综述的目的是研究严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）感染与代谢综合征各单项病症之间的关系。通过查阅原始研究、病例研究和其他二次研究，实现了本次二次文献综述的目的，以全面了解COVID-19病因与代谢综合征的理论和观察结果。关于糖尿病、高血压和肥胖的研究最为广泛，得出了多种（有时相互矛盾）的假设病理生理学。关于血脂异常和COVID-19的资料较少，未能提供同样全面的情况，凸显了进一步研究的必要性。研究得出结论，高血压与COVID-19发病率的相关性最强（其次是肥胖），但其致病病理生理学尚不明确；最有可能与肾素-血管紧张素-醛固酮系统（RAAS）失衡导致的心血管、血管紧张素转换酶2（ACE-2）相关并发症有关。肥胖也与COVID-19病例的严重程度呈正相关，除了与丰富脂肪组织上ACE-2的表达存在假设联系外，还被认为会导致呼吸机械困难。糖尿病被认为通过产生慢性炎症状态并干扰中性粒细胞和T细胞功能，导致COVID-19病情加重。此外，有迹象表明COVID-19可能诱发急性糖尿病和糖尿病酮症酸中毒。最后，得出结论认为血脂异常可能通过增强脂筏和免疫抑制功能促进SARS-CoV-2感染。也有迹象表明胆固醇水平可能具有预后指示作用，他汀类药物可能具有治疗益处。
