SARS and MERS: recent insights into emerging coronaviruses.
SARS and MERS: recent insights into emerging coronaviruses.
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DOI：
10.1038/nrmicro.2016.81
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发表时间：
2016-08
期刊：
影响因子：
--
通讯作者：
Munster VJ
中科院分区：
文献类型：
--
作者：
de Wit E;van Doremalen N;Falzarano D;Munster VJ
严重急性呼吸综合征冠状病毒（SARS-CoV）和中东呼吸综合征冠状病毒（MERS-CoV）是可引起人类严重呼吸道疾病的人畜共患病原体。虽然SARS和MERS的疾病进展相当相似，但MERS的病死率远高于SARS。合并症在SARS和MERS中起着重要作用。在SARS和MERS病例中，有几个危险因素与进展为急性呼吸窘迫综合征（ARDS）相关，特别是高龄和男性。对于MERS，与严重疾病相关的其他风险因素包括慢性疾病，如糖尿病、高血压、癌症、肾脏和肺部疾病以及合并感染。虽然SARS-CoV和MERS-CoV的祖先可能在蝙蝠中传播，但SARS-CoV的人畜共患传播需要偶然的扩增宿主。单峰骆驼是中东呼吸综合征冠状病毒的宿主，人畜共患传染病从该宿主传播;血清学证据表明，中东呼吸综合征冠状病毒样病毒已在单峰骆驼中传播至少30年。SARS-CoV和MERS-CoV的人际传播主要发生在医疗机构。患者在症状出现很久之后才大量排出病毒，此时患者很可能已经在寻求医疗护理。对MERS患者治疗后的医院表面进行的分析显示，感染性病毒无处不在。我们对SARS-CoV和MERS-CoV的发病机制的理解仍然不完全，但下呼吸道病毒复制和异常免疫反应的结合被认为在这两种综合征的严重程度中起着至关重要的作用。由新出现的冠状病毒引起的疾病的严重性突出了开发针对这些病毒的有效治疗措施的必要性。尽管在动物模型和体外研究中已经确定了SARS和MERS的几种治疗方法（基于药物或中和抗体抑制病毒复制，或抑制宿主反应），但迫切需要来自人体临床试验的疗效数据。本文的在线版本（doi：10.1038/nrmicro.2016.81）包含补充材料，可供授权用户使用。从SARS和MERS爆发中获得的对冠状病毒出现、复制和发病机制的见解指导了预防和治疗措施的发展。在这篇综述中，Munster及其同事强调了最近的成就和需要解决的领域，以对抗新型冠状病毒。本文的在线版本（doi：10.1038/nrmicro.2016.81）包含补充材料，可供授权用户使用。2012年中东呼吸综合征冠状病毒（MERS-CoV）的出现标志着高致病性冠状病毒在21世纪第二次引入人类。中东呼吸综合征冠状病毒不断从单峰骆驼传入、随后与旅行有关的病毒传播、前所未有的医院暴发和高病死率，突出表明需要采取预防和治疗措施。自2002-2003年严重急性呼吸道综合征冠状病毒（SARS-CoV）大流行以来，科学进步使我们对MERS-CoV的流行病学和发病机制以及治疗方法的发展有了快速的了解。在这篇综述中，我们详细介绍了我们目前对SARS-CoV和MERS-CoV的传播和发病机制的理解，并讨论了对抗新冠病毒的措施的发展现状。本文的在线版本（doi：10.1038/nrmicro.2016.81）包含补充材料，可供授权用户使用。
Severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV) are zoonotic pathogens that can cause severe respiratory disease in humans. Although disease progression is fairly similar for SARS and MERS, the case fatality rate of MERS is much higher than that of SARS. Comorbidities have an important role in SARS and MERS. Several risk factors are associated with progression to acute respiratory distress syndrome (ARDS) in SARS and MERS cases, especially advanced age and male sex. For MERS, additional risk factors that are associated with severe disease include chronic conditions such as diabetes mellitus, hypertension, cancer, renal and lung disease, and co-infections. Although the ancestors of SARS-CoV and MERS-CoV probably circulate in bats, zoonotic transmission of SARS-CoV required an incidental amplifying host. Dromedary camels are the MERS-CoV reservoir from which zoonotic transmission occurs; serological evidence indicates that MERS-CoV-like viruses have been circulating in dromedary camels for at least three decades. Human-to-human transmission of SARS-CoV and MERS-CoV occurs mainly in health care settings. Patients do not shed large amounts of virus until well after the onset of symptoms, when patients are most probably already seeking medical care. Analysis of hospital surfaces after the treatment of patients with MERS showed the ubiquitous presence of infectious virus. Our understanding of the pathogenesis of SARS-CoV and MERS-CoV is still incomplete, but the combination of viral replication in the lower respiratory tract and an aberrant immune response is thought to have a crucial role in the severity of both syndromes. The severity of the diseases that are caused by emerging coronaviruses highlights the need to develop effective therapeutic measures against these viruses. Although several treatments for SARS and MERS (based on inhibition of viral replication with drugs or neutralizing antibodies, or on dampening the host response) have been identified in animal models and in vitro studies, efficacy data from human clinical trials are urgently required. The online version of this article (doi:10.1038/nrmicro.2016.81) contains supplementary material, which is available to authorized users. Insights into coronavirus emergence, replication and pathogenesis gained from the SARS and MERS outbreaks have guided the development of preventive and therapeutic measures. In this Review, Munster and colleagues highlight recent achievements and areas that need to be addressed to combat novel coronaviruses. The online version of this article (doi:10.1038/nrmicro.2016.81) contains supplementary material, which is available to authorized users. The emergence of Middle East respiratory syndrome coronavirus (MERS-CoV) in 2012 marked the second introduction of a highly pathogenic coronavirus into the human population in the twenty-first century. The continuing introductions of MERS-CoV from dromedary camels, the subsequent travel-related viral spread, the unprecedented nosocomial outbreaks and the high case-fatality rates highlight the need for prophylactic and therapeutic measures. Scientific advancements since the 2002–2003 severe acute respiratory syndrome coronavirus (SARS-CoV) pandemic allowed for rapid progress in our understanding of the epidemiology and pathogenesis of MERS-CoV and the development of therapeutics. In this Review, we detail our present understanding of the transmission and pathogenesis of SARS-CoV and MERS-CoV, and discuss the current state of development of measures to combat emerging coronaviruses. The online version of this article (doi:10.1038/nrmicro.2016.81) contains supplementary material, which is available to authorized users.
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