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新冠后综合征的机制、预防与管理。

Post-COVID-19 Syndrome Mechanisms, Prevention and Management.

作者信息

Najafi Majed B, Javanmard Shaghayegh H

机构信息

Applied Physiology Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

出版信息

Int J Prev Med. 2023 May 24;14:59. doi: 10.4103/ijpvm.ijpvm_508_21. eCollection 2023.

Abstract

As the population of patients recovering from COVID-19 grows, post COVID-19 challenges are recognizing by ongoing evidences at once. Long COVID is defined as a syndrome with a range of persistent symptoms that remain long after (beyond 12 weeks) the acute SARS-CoV-2 infection. Studies have shown that long COVID can cause multi-organ damages with a wide spectrum of manifestations. Many systems, but not limited to, including respiratory, cardiovascular, nervous, gastrointestinal, and musculoskeletal systems, are involved in long COVID. Fatigue and dyspnea are the most common symptoms of long COVID. Long COVID-19 may be driven by tissue damage caused by virus-specific pathophysiologic changes or secondary to pathological long-lasting inflammatory response because of viral persistence, immune dysregulation, and autoimmune reactions. Some risk factors like sex and age, more than five early symptoms, and specific biomarkers have been revealed as a probable long COVID predicator discussed in this review. It seems that vaccination is the only way for prevention of long COVID and it can also help patients who had already long COVID. Managing long COVID survivors recommended being in a multidisciplinary approach, and a framework for identifying those at high risk for post-acute COVID-19 must be proposed. Possible therapeutic options and useful investigation tools for follow-up are suggested in this review. In sum, as evidence and researches are regularly updated, we provide the current understanding of the epidemiology, clinical manifestation, suspected pathophysiology, associated risk factors, and treatment options of long COVID in this review.

摘要

随着从新冠病毒感染中康复的患者人数不断增加,新冠后遗症问题立刻被越来越多的证据所证实。新冠后遗症被定义为一种综合征,在严重急性呼吸综合征冠状病毒2(SARS-CoV-2)急性感染后很长时间(超过12周)仍存在一系列持续症状。研究表明,新冠后遗症可导致多器官损害,表现形式多种多样。许多系统都与新冠后遗症有关,包括但不限于呼吸系统、心血管系统、神经系统、胃肠道系统和肌肉骨骼系统。疲劳和呼吸困难是新冠后遗症最常见的症状。新冠后遗症可能是由病毒特异性病理生理变化引起的组织损伤所致,也可能是由于病毒持续存在、免疫失调和自身免疫反应导致的病理性长期炎症反应所致。本文综述讨论了一些可能是新冠后遗症预测指标的危险因素,如性别和年龄、五种以上的早期症状以及特定的生物标志物。接种疫苗似乎是预防新冠后遗症的唯一方法,对已经出现新冠后遗症的患者也有帮助。对新冠后遗症康复者的管理建议采用多学科方法,并且必须提出一个识别急性新冠后综合征高危人群的框架。本文综述还提出了可能的治疗选择和后续有用的调查工具。总之,随着证据和研究的不断更新,我们在本文综述中提供了对新冠后遗症的流行病学、临床表现、疑似病理生理学、相关危险因素和治疗选择的当前认识。

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