Hirotsu Yosuke, Kakizaki Yumiko, Saito Akitoshi, Tsutsui Toshiharu, Hanawa Syunya, Yamaki Haruna, Ide Syuichiro, Kawaguchi Makoto, Kobayashi Hiroaki, Miyashita Yoshihiro, Omata Masao
Genome Analysis Center, Yamanashi Central Hospital, 1-1-1 Fujimi, Kofu, Yamanashi, Japan.
Lung Cancer and Respiratory Disease Center, Yamanashi Central Hospital, 1-1-1 Fujimi, Kofu, Yamanashi, Japan.
Commun Med (Lond). 2023 Feb 25;3(1):32. doi: 10.1038/s43856-023-00261-5.
The genetic and pathogenic characteristics of SARS-CoV-2 have evolved from the original isolated strains; however, the changes in viral virulence have not been fully defined. In this study, we analyzed the association between the severity of the pathogenesis of pneumonia in humans and SARS-CoV-2 variants that have been prevalent to date.
We examined changes in the variants and tropism of SARS-CoV-2. A total of 514 patients admitted between February 2020 and August 2022 were included and evaluated for pneumonia by computed tomography (CT) as a surrogate of viral tropism.
The prevalence of pneumonia for each variant was as follows: D614G (57%, 65/114), Alpha (67%, 41/61), Delta (49%, 41/84), Omicron BA.1.1 (26%, 43/163), and Omicron BA.2 (11%, 10/92). The pneumonia prevalence in unvaccinated patients progressively declined from 70% to 11% as the variants changed: D614G (56%, 61/108), Alpha (70%, 26/37), Delta (60%, 38/63), BA.1.1 (52%, 15/29), and BA.2 (11%, 2/19). The presence of pneumonia in vaccinated patients was as follows: Delta (16%, 3/19), BA.1.1 (21%, 27/129), and BA.2 (11%, 8/73). Compared with D614G, the areas of lung involvement were also significantly reduced in BA.1.1 and BA.2 variants.
Compared with previous variants, there was a marked decrease in pneumonia prevalence and lung involvement in patients infected with Omicron owing to decreased tropism in the lungs that hindered viral proliferation in the alveolar epithelial tissue. Nevertheless, older, high-risk patients with comorbidities who are infected with an Omicron variant can still develop pneumonia and require early treatment.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的基因和致病特征已从最初分离的毒株演变而来；然而，病毒毒力的变化尚未完全明确。在本研究中，我们分析了人类肺炎发病严重程度与迄今流行的SARS-CoV-2变异株之间的关联。
我们检测了SARS-CoV-2变异株和嗜性的变化。纳入了2020年2月至2022年8月期间收治的514例患者，并通过计算机断层扫描（CT）评估肺炎情况，以此作为病毒嗜性的替代指标。
各变异株的肺炎患病率如下：D614G（57%，65/114）、阿尔法（Alpha，67%，41/61）、德尔塔（Delta，49%，41/84）、奥密克戎BA.1.1（26%，43/163）和奥密克戎BA.2（11%，10/92）。随着变异株的变化，未接种疫苗患者的肺炎患病率从70%逐渐下降至11%：D614G（56%，61/108）、阿尔法（70%，26/37）、德尔塔（60%，38/63）、BA.1.1（52%，15/29）和BA.2（11%，2/19）。接种疫苗患者的肺炎情况如下：德尔塔（16%，3/19）、BA.1.1（21%，27/129）和BA.2（11%，8/73）。与D614G相比，BA.1.1和BA.2变异株的肺部受累面积也显著减小。
与先前的变异株相比，感染奥密克戎的患者肺炎患病率和肺部受累情况明显降低，这是由于肺部嗜性降低，阻碍了病毒在肺泡上皮组织中的增殖。然而，感染奥密克戎变异株的老年、高危合并症患者仍可能发生肺炎，需要早期治疗。
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