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“长新冠”与病毒性“纤维肌痛样症状”:提示筋膜肌成纤维细胞的机制性作用(尼尼微,阴影在筋膜中)

"Long COVID-19" and viral "fibromyalgia-ness": Suggesting a mechanistic role for fascial myofibroblasts (Nineveh, the shadow is in the fascia).

作者信息

Plaut Shiloh

机构信息

Department of Basic and Clinical Sciences, University of Nicosia Medical School, Nicosia, Cyprus.

出版信息

Front Med (Lausanne). 2023 Apr 6;10:952278. doi: 10.3389/fmed.2023.952278. eCollection 2023.

Abstract

The coronavirus pandemic has led to a wave of chronic disease cases; "Long COVID-19" is recognized as a new medical entity and resembles "fibromyalgia" which, likewise, lacks a clear mechanism. Observational studies indicate that up to 30%-40% of convalescent COVID-19 patients develop chronic widespread pain and fatigue and fulfill the 2016 diagnostic criteria for "fibromyalgia." A recent study suggested a theoretical neuro-biomechanical model (coined "Fascial Armoring") to help explain the pathogenesis and cellular pathway of fibromyalgia, pointing toward mechanical abnormalities in connective tissue and fascia, driven by contractile myo/fibroblasts and altered extracellular matrix remodeling with downstream corresponding neurophysiological aberrations. This may help explain several of fibromyalgia's manifestations such as pain, distribution of pain, trigger points/tender spots, hyperalgesia, chronic fatigue, cardiovascular abnormalities, metabolic abnormalities, autonomic abnormalities, small fiber neuropathy, various psychosomatic symptoms, lack of obvious inflammation, and silent imaging investigations. Pro-inflammatory and pro-fibrotic pathways provide input into this mechanism stimulation of proto/myofibroblasts. In this hypothesis and theory paper the theoretical model of Fascial Armoring is presented to help explain the pathogenesis and manifestations of "long COVID-19" as a disease of immuno-rheumo-psycho-neurology. The model is also used to make testable experimental predictions on investigations and predict risk and relieving factors.

摘要

新冠疫情导致了一波慢性病病例;“长新冠”被公认为一种新的医学实体,与“纤维肌痛”相似,而纤维肌痛同样缺乏明确的发病机制。观察性研究表明,高达30%-40%的新冠康复患者会出现慢性广泛性疼痛和疲劳,并符合2016年“纤维肌痛”的诊断标准。最近的一项研究提出了一种理论神经生物力学模型(称为“筋膜铠甲”),以帮助解释纤维肌痛的发病机制和细胞途径,指出结缔组织和筋膜存在机械异常,这是由收缩性肌成纤维细胞驱动的,同时细胞外基质重塑改变,并伴有下游相应的神经生理异常。这可能有助于解释纤维肌痛的一些表现,如疼痛、疼痛分布、触发点/压痛点、痛觉过敏、慢性疲劳、心血管异常、代谢异常、自主神经异常、小纤维神经病变、各种心身症状、缺乏明显炎症以及影像学检查无异常。促炎和促纤维化途径为这一机制提供了输入 对原成纤维细胞/肌成纤维细胞的刺激。在这篇假说与理论论文中,提出了筋膜铠甲的理论模型,以帮助解释“长新冠”作为一种免疫-风湿-心理-神经疾病的发病机制和表现。该模型还用于对研究做出可检验的实验预测,并预测风险和缓解因素。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/503e/10117846/b0f92f303195/fmed-10-952278-g001.jpg

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