Department of Otolaryngology - Head & Neck Surgery, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore.
Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Curr Allergy Asthma Rep. 2023 Feb;23(2):121-131. doi: 10.1007/s11882-022-01059-6. Epub 2023 Jan 4.
While the predominant cause for morbidity and mortality with SARS-CoV-2 infection is the lower respiratory tract manifestations of the disease, the effects of SARS-CoV-2 infection on the sinonasal tract have also come to the forefront especially with the increased recognition of olfactory symptom. This review presents a comprehensive summary of the mechanisms of action of the SARS-CoV-2 virus, sinonasal pathophysiology of COVID-19, and the correlation with the clinical and epidemiological impact on olfactory dysfunction.
ACE2 and TMPRSS2 receptors are key players in the mechanism of infection of SARS-CoV-2. They are present within both the nasal respiratory as well as olfactory epithelia. There are however differences in susceptibility between different groups of individuals, as well as between the different SARS-CoV-2 variants. The sinonasal cavity is an important route for SARS-CoV-2 infection. While the mechanism of infection of SARS-CoV-2 in nasal respiratory and olfactory epithelia is similar, there exist small but significant differences in the susceptibility of these epithelia and consequently clinical manifestations of the disease. Understanding the differences and nuances in sinonasal pathophysiology in COVID-19 would allow the clinician to predict and counsel patients suffering from COVID-19. Future research into molecular pathways and cytokine responses at different stages of infection and different variants of SARS-CoV-2 would evaluate the individual clinical phenotype, prognosis, and possibly response to vaccines and therapeutics.
虽然 SARS-CoV-2 感染的主要发病和死亡原因是下呼吸道疾病的表现，但 SARS-CoV-2 感染对鼻-鼻窦的影响也越来越受到关注，尤其是嗅觉症状的认识不断提高。本篇综述全面总结了 SARS-CoV-2 病毒的作用机制、COVID-19 的鼻-鼻窦病理生理学，以及与嗅觉功能障碍的临床和流行病学相关性。
ACE2 和 TMPRSS2 受体是 SARS-CoV-2 感染的关键因素。它们存在于鼻呼吸和嗅觉上皮中。然而，不同个体之间以及不同 SARS-CoV-2 变异体之间的易感性存在差异。鼻-鼻窦腔是 SARS-CoV-2 感染的重要途径。虽然 SARS-CoV-2 在鼻呼吸和嗅觉上皮中的感染机制相似，但这些上皮的易感性存在微小但显著的差异，从而导致疾病的临床表现也存在差异。了解 COVID-19 中鼻-鼻窦病理生理学的差异和细微差别，将使临床医生能够预测和为 COVID-19 患者提供咨询。未来对感染不同阶段和不同 SARS-CoV-2 变异体的分子途径和细胞因子反应的研究，将评估个体的临床表型、预后，以及对疫苗和治疗的反应。
