Ghotbi Zahra, Estakhr Mehrdad, Hosseini Melika, Shahripour Reza Bavarsad
Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz P.O. Box 71348-14336, Iran.
Comprehensive Stroke Center, Department of Neurosciences, Loma Linda University, Loma Linda, CA 92354, USA.
Life (Basel). 2023 Jul 24;13(7):1614. doi: 10.3390/life13071614.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) primarily affects the respiratory system but can also lead to neurological complications. Among COVID-19 patients, the endothelium is considered the Achilles heel. A variety of endothelial dysfunctions may result from SARS-CoV-2 infection and subsequent endotheliitis, such as altered vascular tone, oxidative stress, and cytokine storms. The cerebral hemodynamic impairment that is caused is associated with a higher probability of severe disease and poor outcomes in patients with COVID-19. This review summarizes the most relevant literature on the role of vasomotor reactivity (VMR) in COVID-19 patients. An overview of the research articles is presented. Most of the studies have supported the hypothesis that endothelial dysfunction and cerebral VMR impairment occur in COVID-19 patients. Researchers believe these alterations may be due to direct viral invasion of the brain or indirect effects, such as inflammation and cytokines. Recently, researchers have concluded that viruses such as the Human Herpes Virus 8 and the Hantavirus predominantly affect endothelial cells and, therefore, affect cerebral hemodynamics. Especially in COVID-19 patients, impaired VMR is associated with a higher risk of severe disease and poor outcomes. Using VMR, one can gain valuable insight into a patient's disease progression and make more informed decisions regarding appropriate treatment options. A new pandemic may develop with the COVID-19 virus or other viruses, making it essential that healthcare providers and researchers remain focused on developing new strategies for improving survival in such patients, particularly those with cerebrovascular risk factors.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）主要影响呼吸系统，但也可导致神经并发症。在新冠肺炎患者中，内皮被认为是致命弱点。SARS-CoV-2感染及随后的内皮炎可能导致多种内皮功能障碍，如血管张力改变、氧化应激和细胞因子风暴。由此引起的脑血流动力学损害与新冠肺炎患者发生重症和不良预后的可能性较高相关。本综述总结了关于血管运动反应性（VMR）在新冠肺炎患者中作用的最相关文献。呈现了研究文章的概述。大多数研究支持了新冠肺炎患者存在内皮功能障碍和脑VMR损害这一假说。研究人员认为这些改变可能是由于病毒直接侵袭大脑或间接影响，如炎症和细胞因子。最近，研究人员得出结论，人类疱疹病毒8型和汉坦病毒等病毒主要影响内皮细胞，因此影响脑血流动力学。尤其是在新冠肺炎患者中，VMR受损与重症和不良预后的较高风险相关。通过VMR，可以深入了解患者的疾病进展，并就适当的治疗方案做出更明智的决策。可能会出现由新冠病毒或其他病毒引发的新的大流行，因此医疗服务提供者和研究人员必须继续专注于制定新策略，以提高此类患者，尤其是有脑血管危险因素患者的生存率。
