Hatem Ban Adnan, Jabir Ferdous A
Chemistry Department, College of Science, Al-Qadisiyah University, Al Diwaniyah, Iraq.
Biochemistry Department, College of Medicine, Al-Qadisiyah University, Al Diwaniyah, Iraq.
Biochem Genet. 2024 Jul 31. doi: 10.1007/s10528-024-10890-7.
COVID-19 patients experience a complex interplay involving ACE2, thrombin, D-dimer, and lipid profile, yet its full understanding remains elusive. ACE2, a pivotal regulator of the renin-angiotensin system and the primary receptor for SARS-CoV-2 undergoes downregulation upon viral binding, potentially leading to severe cases with acute respiratory distress syndrome (ARDS). A specific ACE2 gene polymorphism (rs2285666) may be associated with COVID-19 susceptibility, with the A allele potentially increasing infection risk. COVID-19 disease progression is linked to coagulation abnormalities, but the exact connection with thrombin and D-dimer remains uncertain. A study examining coagulation parameters in COVID-19 patients admitted to Al-Diwania Educational Hospital from February to May 2022 found that thrombin and D-dimer levels were directly related to disease severity. Severe cases exhibited significantly altered coagulation function compared to mild and recovered cases, with notably higher D-dimer levels and elevated thrombin serum concentrations. Moreover, dyslipidemia, particularly low HDL cholesterol, is a prevalent comorbidity in COVID-19 patients and may be linked to worse outcomes. In conclusion, COVID-19 is associated with a prothrombotic state and dysregulation of the renin-angiotensin system due to ACE2 downregulation following viral binding. The intricate interplay between ACE2, thrombin, D-dimer, and lipid profile necessitates further investigation. The multifaceted nature of the disease demands continued research to unravel its pathogenesis and identify potential therapeutic targets.
新冠病毒肺炎患者存在涉及血管紧张素转换酶2（ACE2）、凝血酶、D-二聚体和血脂谱的复杂相互作用，但其全貌仍不清楚。ACE2是肾素-血管紧张素系统的关键调节因子，也是严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的主要受体，病毒结合后会发生下调，可能导致急性呼吸窘迫综合征（ARDS）的重症病例。一种特定的ACE2基因多态性（rs2285666）可能与新冠病毒肺炎易感性有关，A等位基因可能增加感染风险。新冠病毒肺炎的疾病进展与凝血异常有关，但与凝血酶和D-二聚体的确切联系仍不确定。一项对2022年2月至5月入住迪瓦尼亚教育医院的新冠病毒肺炎患者凝血参数的研究发现，凝血酶和D-二聚体水平与疾病严重程度直接相关。与轻症和康复病例相比，重症病例的凝血功能有显著改变，D-二聚体水平明显更高，凝血酶血清浓度升高。此外，血脂异常，尤其是高密度脂蛋白胆固醇水平低，是新冠病毒肺炎患者中普遍存在的合并症，可能与更差的预后有关。总之，新冠病毒肺炎与病毒结合后ACE2下调导致的血栓前状态和肾素-血管紧张素系统失调有关。ACE2、凝血酶、D-二聚体和血脂谱之间的复杂相互作用需要进一步研究。该疾病的多面性要求持续开展研究以阐明其发病机制并确定潜在的治疗靶点。
