Catecholamine physiology and its implications in patients with COVID-19.
Catecholamine physiology and its implications in patients with COVID-19.
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DOI：
10.1016/s2213-8587(20)30342-9
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发表时间：
2020-12
期刊：
影响因子：
--
通讯作者：
Pacak K
中科院分区：
文献类型：
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作者：
Gubbi S;Nazari MA;Taieb D;Klubo-Gwiezdzinska J;Pacak K
重症COVID-19的危险因素多种多样，但与儿茶酚胺过量状态（例如高血压、心血管疾病、免疫失调和高血糖）的临床表现非常相似，这表明疾病存在潜在的共同基础。不幸的是，COVID-19 引起的严重疾病（例如呼吸衰竭、心脏功能受损和休克）阻碍了对这些患者进行儿茶酚胺的直接研究，特别是对于那些服用多种药物或注射肾上腺素或去甲肾上腺素或两者兼而有之的患者。嗜铬细胞瘤和副神经节瘤（PPGL）是分泌儿茶酚胺（即肾上腺素和去甲肾上腺素）的肿瘤，通常分泌过量。 PPGL 是经过充分研究的疾病过程，其中儿茶酚胺的作用很容易辨别，因此可以探索它们对 COVID-19 患者的潜在生化和生理影响。由于儿茶酚胺预计对危重患者、接受血管加压药输注的患者以及承受某些急性和慢性身体应激的患者发挥作用，因此管理儿茶酚胺过量状态所涉及的挑战与 COVID-19 患者的治疗直接相关。在本个人观点中，我们讨论了儿茶酚胺与 COVID-19 之间复杂的相互作用，以及儿茶酚胺过量状态的管理，同时参考了 PPGL 研究中得出的相关见解。
The risk factors for severe COVID-19 are diverse, yet closely resemble the clinical manifestations of catecholamine excess states (eg, hypertension, cardiovascular disease, immune dysregulation, and hyperglycaemia), suggesting a potentially common basis for disease. Unfortunately, severe illness (eg, respiratory failure, compromised cardiac function, and shock) incurred by COVID-19 hinders the direct study of catecholamines in these patients, especially among those on multiple medications or those on adrenaline or noradrenaline infusions, or both. Phaeochromocytoma and paraganglioma (PPGL) are tumours that secrete catecholamines, namely adrenaline and noradrenaline, often in excess. PPGL are well studied disease processes in which the effects of catecholamines are easily discernible and therefore their potential biochemical and physiological influences in patients with COVID-19 can be explored. Because catecholamines are expected to have a role in patients with critical illness, patients on vasopressor infusions, and patients who sustain some acute and chronic physical stresses, the challenges involved in the management of catecholamine excess states are directly relevant to the treatment of patients with COVID-19. In this Personal View, we discuss the complex interplay between catecholamines and COVID-19, and the management of catecholamine excess states, while referencing relevant insights derived from the study of PPGL.