Department of Pharmacology and Therapeutics, Faculty of Veterinary Medicine, Damanhour University, Damanhour, Al Beheira, 22511, Egypt.
Department of Clinical Pharmacology and Medicine, College of Medicine, ALmustansiriyia University, Baghdad, Iraq.
Virol J. 2022 Oct 9;19(1):158. doi: 10.1186/s12985-022-01891-2.
Most COVID-19 patients recovered with low mortality; however, some patients experienced long-term symptoms described as "long-COVID" or "Post-COVID syndrome" (PCS). Patients may have persisting symptoms for weeks after acute SARS-CoV-2 infection, including dyspnea, fatigue, myalgia, insomnia, cognitive and olfactory disorders. These symptoms may last for months in some patients. PCS may progress in association with the development of mast cell activation syndrome (MCAS), which is a distinct kind of mast cell activation disorder, characterized by hyper-activation of mast cells with inappropriate and excessive release of chemical mediators. COVID-19 survivors, mainly women, and patients with persistent severe fatigue for 10 weeks after recovery with a history of neuropsychiatric disorders are more prone to develop PCS. High D-dimer levels and blood urea nitrogen were observed to be risk factors associated with pulmonary dysfunction in COVID-19 survivors 3 months post-hospital discharge with the development of PCS. PCS has systemic manifestations that resolve with time with no further complications. However, the final outcomes of PCS are chiefly unknown. Persistence of inflammatory reactions, autoimmune mimicry, and reactivation of pathogens together with host microbiome alterations may contribute to the development of PCS. The deregulated release of inflammatory mediators in MCAS produces extraordinary symptoms in patients with PCS. The development of MCAS during the course of SARS-CoV-2 infection is correlated to COVID-19 severity and the development of PCS. Therefore, MCAS is treated by antihistamines, inhibition of synthesis of mediators, inhibition of mediator release, and inhibition of degranulation of mast cells.
大多数 COVID-19 患者康复后死亡率较低；然而，一些患者经历了被称为“长新冠”或“新冠后综合征”（PCS）的长期症状。患者在急性 SARS-CoV-2 感染后可能会持续数周出现呼吸困难、疲劳、肌肉疼痛、失眠、认知和嗅觉障碍等症状。在一些患者中，这些症状可能会持续数月。PCS 可能会随着肥大细胞活化综合征（MCAS）的发展而进展，MCAS 是一种独特的肥大细胞活化障碍，其特征是肥大细胞过度激活，化学介质过度释放。COVID-19 幸存者，主要是女性，以及在康复后 10 周持续出现严重疲劳且有神经精神障碍病史的患者，更容易发展为 PCS。在 COVID-19 幸存者出院 3 个月后，高 D-二聚体水平和血尿素氮被观察到是与肺功能障碍相关的危险因素，同时也会发展为 PCS。PCS 有全身性表现，随着时间的推移会自行缓解，不会有进一步的并发症。然而，PCS 的最终结局主要是未知的。炎症反应的持续存在、自身免疫模拟和病原体的再激活以及宿主微生物组的改变可能导致 PCS 的发展。MCAS 中炎症介质的失调释放会导致 PCS 患者出现异常症状。在 SARS-CoV-2 感染过程中 MCAS 的发展与 COVID-19 的严重程度和 PCS 的发展相关。因此，MCAS 通过抗组胺药、介质合成抑制剂、介质释放抑制剂和肥大细胞脱颗粒抑制剂来治疗。
