School of Medicine, American University of Health Sciences, 1600 East Hill St., Signal Hill/Long Beach, CA, 90755, USA.
Department of Pulmonology, Semmelweis University, Budapest, Hungary.
Inflammopharmacology. 2023 Apr;31(2):551-557. doi: 10.1007/s10787-023-01194-0. Epub 2023 Mar 25.
The previous acute respiratory diseases caused by viruses originating from China or the middle east (e.g., SARS, MERS) remained fast developing short diseases without major sequalae or any long-lasting complications. The new COVID-19, on the other hand, not only that it rapidly spread over the world, but some patients never fully recovered or even if they did, a few weeks later started to complain not only of shortness of breath, if any, but general weakness, muscle pains and 'brain fog', i.e., fuzzy memories. Thus, these signs and symptoms were eventually labelled 'long COVID', for which the most widely used definition is 'new signs and symptoms occurring 4-8 weeks after recovering from acute stage of COVID-19'. The other most frequent manifestations associated with long COVID include headache, loss of memory, smell and of hair, nausea, and vomiting. Thus, long COVID is not a simple disease, but complex disorder of several organ systems malfunctioning; hence, it is probably more appropriate to call this a syndrome. The pathogenesis of long COVID syndrome is poorly understood, but initial and persistent vascular endothelial injury that often triggers the formation of microthrombi that if dislodged as emboli, damage several organs, especially in the brain, heart and kidney, by creating microinfarcts. The other major contributory mechanistic factor is the persistent cytokine storm that may last longer in long COVID patients than in others, probably triggered by aggregates of SARS-Co-2 discovered recently in the adrenal cortex, kidney and brain. The prevalence of long COVID is relatively high, e.g., initially varied 3-30%, and recent data indicate that 2.5% of UK population suffers from this syndrome, while in the US 14.7% of acute COVID-19 patients continued to have symptoms longer than 2 months. Thus, the long COVID syndrome deserves to be further investigated, both from clinical and basic research perspectives.
先前由源自中国或中东的病毒引起的急性呼吸道疾病（例如 SARS、MERS）仍然是快速发展的短期疾病，没有重大后遗症或任何长期并发症。另一方面，新的 COVID-19 不仅迅速在全球传播，而且一些患者从未完全康复，甚至即使康复了，几周后开始抱怨不仅呼吸急促，如果有的话，而且全身无力、肌肉疼痛和“脑雾”，即模糊的记忆。因此，这些症状最终被标记为“长新冠”，最广泛使用的定义是“在从 COVID-19 的急性阶段恢复后 4-8 周出现的新症状和体征”。与长新冠相关的另一个最常见的表现包括头痛、记忆力减退、嗅觉和头发丧失、恶心和呕吐。因此，长新冠不是一种简单的疾病，而是几个器官系统功能障碍的复杂疾病；因此，称其为综合征可能更为恰当。长新冠综合征的发病机制尚不清楚，但初始和持续的血管内皮损伤经常引发微血栓形成，如果作为栓子脱落，会损害几个器官，特别是大脑、心脏和肾脏，从而形成微梗死。另一个主要的促成机制是持续的细胞因子风暴，在长新冠患者中可能比在其他人中持续时间更长，可能是由最近在肾上腺皮质、肾脏和大脑中发现的 SARS-CoV-2 聚集物触发的。长新冠的患病率相对较高，例如，最初为 3-30%，最近的数据表明，英国有 2.5%的人口患有这种综合征，而在美国，14.7%的急性 COVID-19 患者的症状持续时间超过 2 个月。因此，长新冠综合征值得进一步研究，从临床和基础研究的角度来看都是如此。
