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新型冠状病毒肺炎与自身免疫性疾病:存在关联吗?

COVID-19 and autoimmune diseases: is there a connection?

作者信息

Votto Martina, Castagnoli Riccardo, Marseglia Gian Luigi, Licari Amelia, Brambilla Ilaria

机构信息

Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia.

Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.

出版信息

Curr Opin Allergy Clin Immunol. 2023 Apr 1;23(2):185-192. doi: 10.1097/ACI.0000000000000888. Epub 2023 Jan 11.

Abstract

PURPOSE OF REVIEW

This review summarizes current evidence on the potential link between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and autoimmunity.

RECENT FINDINGS

Several viral infections are potential triggers of reactive and autoimmune diseases by inducing type II and type IV hypersensitivity reactions. Recent evidence demonstrated that SARS-CoV-2 infection is not an exception, triggering the production of tissue-specific autoantibodies during the acute phase of coronavirus disease 2019 (COVID-19) and leading to autoimmune diseases development as long-term complication. The significant immune dysregulation with cytokine storm and organ damage observed in patients with severe to critical COVID-19 is considered the main mechanism explaining the high levels of autoantibodies, which are also implicated in disease severity and the need for an intensive care assessment. Multisystem inflammatory syndrome in children (MIS-C) is an immune-mediated disease where the recent viral infection leads to systemic inflammation, as already observed in other reactive and autoimmune diseases.

SUMMARY

Autoimmunity may be a complication of SAR-CoV-2 infection. Understanding the pathogenesis of autoimmune manifestations in COVID-19 might help prevent the incidence or exacerbation of autoimmune disorders and design better and more efficient treatment strategies in children and adult populations.

摘要

综述目的

本综述总结了关于严重急性呼吸综合征冠状病毒2(SARS-CoV-2)感染与自身免疫之间潜在联系的当前证据。

最新发现

几种病毒感染可通过诱导II型和IV型超敏反应,成为反应性和自身免疫性疾病的潜在触发因素。最近的证据表明,SARS-CoV-2感染也不例外,在2019冠状病毒病(COVID-19)急性期引发组织特异性自身抗体的产生,并导致自身免疫性疾病作为长期并发症发展。在重症至危重症COVID-19患者中观察到的伴有细胞因子风暴和器官损伤的显著免疫失调被认为是解释自身抗体高水平的主要机制,自身抗体也与疾病严重程度和重症监护评估需求有关。儿童多系统炎症综合征(MIS-C)是一种免疫介导的疾病,近期病毒感染会导致全身炎症,这在其他反应性和自身免疫性疾病中也有观察到。

总结

自身免疫可能是SARS-CoV-2感染的并发症。了解COVID-19中自身免疫表现的发病机制可能有助于预防自身免疫性疾病的发生或加重,并为儿童和成人人群设计更好、更有效的治疗策略。

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