新型冠状病毒(COVID-19)靶向中枢神经系统的可能机制及神经症状:文献复习。

Possible mechanism of central nervous system targeting and neurological symptoms of the new-coronavirus (COVID-19): literature review.

机构信息

Department of Neurology, Psychiatry and Narcology, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan.

出版信息

Eur Rev Med Pharmacol Sci. 2023 Oct;27(19):9420-9428. doi: 10.26355/eurrev_202310_33970.

Abstract

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that caused the 2019 Coronavirus Disease (COVID-19) has been associated with several neurological symptoms. This review aimed to highlight the possible mechanism of central nervous system (CNS) targeting and the neurological symptoms that may occur with the COVID-19 infection. The case reports containing the keywords "neurological symptoms" and "COVID-19" were thoroughly reviewed to identify possible mechanisms of CNS targeting and neurological manifestations associated with COVID-19 infection. The angiotensin-converting enzyme-2 (ACE2) receptors have been identified as the functional receptor for SARS-CoV-2. SARS-CoV-2 can affect the CNS through the following mechanisms: 1) Direct infection. 2) Blood pathway. 3) Neuronal pathway. 4) Immune-mediated injury/pathway (Cytokine Storm Syndrome). COVID-19 virus, a neurotropic virus, was isolated from the cerebral fluid (CSF) and responsible for several neurological manifestations. The COVID-19 infection primarily affects CD4+ and CD8+ T-lymphocytes and it induces a surge of inflammatory cytokines, known as Cytokine Storm Syndrome (CSS). The Interlukine-6 (IL-6) is the primary CSS component. The IL-6, interferon-γ and endothelial growth factor were significantly higher in COVID-19 infected compared to non-infected individuals. The improvement of the COVID-19 patients after interleukin receptor blockers supports the CSS theory. The spectrum of SARS-CoV-2 neurological manifestations includes encephalitis, viral meningitis, post-COVID-19 infectious acute disseminated encephalitis, Guillain-Barré Syndrome (GBS), Miller-Fisher syndrome (MFS) and acute cerebrovascular disease (CVD). Several COVID-19-associated neurological manifestations have been reported. Thus, it is important to identify and treat neurological symptoms as soon as possible to avoid long-term effects. The care providers should take the appropriate preventive precautions because patients can present with neurological manifestations of COVID-19 without any respiratory symptoms. Future research is warranted to confirm the relationship between SARS-CoV-2 and the development of neurological manifestations.

摘要

导致 2019 年冠状病毒病(COVID-19)的严重急性呼吸综合征冠状病毒 2(SARS-CoV-2)与几种神经系统症状有关。本综述旨在强调中枢神经系统(CNS)靶向的可能机制以及 COVID-19 感染可能发生的神经系统症状。彻底审查了包含关键词“神经系统症状”和“COVID-19”的病例报告,以确定与 COVID-19 感染相关的 CNS 靶向和神经系统表现的可能机制。血管紧张素转换酶 2(ACE2)受体已被确定为 SARS-CoV-2 的功能性受体。SARS-CoV-2 可以通过以下机制影响 CNS:1)直接感染。2)血液途径。3)神经元途径。4)免疫介导的损伤/途径(细胞因子风暴综合征)。COVID-19 病毒是一种嗜神经病毒,从脑脊液(CSF)中分离出来,引起多种神经系统表现。COVID-19 感染主要影响 CD4+和 CD8+T 淋巴细胞,并引起炎症细胞因子的激增,称为细胞因子风暴综合征(CSS)。白细胞介素 6(IL-6)是 CSS 的主要成分。COVID-19 感染患者的白细胞介素 6、干扰素-γ和内皮生长因子明显高于未感染患者。白细胞介素受体阻滞剂治疗 COVID-19 患者后病情改善支持 CSS 理论。SARS-CoV-2 神经系统表现谱包括脑炎、病毒性脑膜炎、COVID-19 后感染性急性播散性脑脊髓炎、吉兰-巴雷综合征(GBS)、米勒-费舍尔综合征(MFS)和急性脑血管病(CVD)。已经报道了几种 COVID-19 相关的神经系统表现。因此,尽快识别和治疗神经系统症状非常重要,以避免长期影响。护理提供者应采取适当的预防措施,因为患者可能会出现 COVID-19 的神经系统表现而没有任何呼吸道症状。需要进一步的研究来证实 SARS-CoV-2 与神经系统表现发展之间的关系。

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