Impact of COVID-19 on Patients with Inflammatory Bowel Disease.
Impact of COVID-19 on Patients with Inflammatory Bowel Disease.
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DOI：
10.14218/jerp.2021.00014
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发表时间：
2022-03
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严重急性呼吸综合征冠状病毒2（SARS-CoV-2）于2019年底在中国武汉首次发现。SARS-CoV-2是导致2019年冠状病毒病（COVID-19）大流行的三种结构相似的β-冠状病毒之一，可导致细胞因子强烈上调，称为细胞因子释放综合征（CRS）。未解决的CRS导致呼吸道症状，包括肺炎，在更严重的情况下，急性呼吸窘迫综合征（ARDS）。尽管COVID-19以这些标志性的呼吸道症状而广为人知，但它也会影响肠道，导致胃肠道（GI）炎症和腹泻。COVID-19的胃肠道症状可能是由于肠道血管紧张素转换酶-2受体的高表达，该受体用于结合SARS-CoV-2病毒颗粒。有报告显示，SARS-CoV-2可以通过粪便传播，一项研究发现，48.1%的COVID-19患者在粪便中表达病毒SARS-CoV-2 mRNA。鉴于胃肠道是受COVID-19影响的靶组织，这引起了患有潜在胃肠道病变（如炎症性肠病（IBD））的患者的担忧。令人遗憾的是，关于COVID-19对肠道健康影响的研究有限，COVID-19对IBD患者肠道炎症的影响仍不清楚。特别是，关于SARS-CoV-2感染的易感性，COVID-19对IBD的临床影响以及年龄，性别和免疫抑制剂药物的潜在影响等问题仍然知之甚少。需要更好地了解这些问题，以解决IBD患者中COVID-19的独特风险，以及SARS-CoV-2对宿主肠道微生物群的潜在影响。
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first identified in Wuhan, China, in late 2019. Responsible for the ongoing coronavirus disease 2019 (COVID-19) pandemic, SARS-CoV-2 is one of three structurally similar beta-coronaviruses that can cause a strong upregulation of cytokines referred to as cytokine release syndrome (CRS). Unresolved CRS leads to respiratory symptoms, including pneumonia, and in more severe cases, acute respiratory distress syndrome (ARDS). Although COVID-19 is widely known for these hallmark respiratory symptoms, it also impacts the gut, causing gastrointestinal (GI) tract inflammation and diarrhea. COVID-19’s GI symptoms may be due to the high intestinal expression of angiotensin converting enzyme-2 receptors, which are for the binding of SARS-CoV-2 viral particles. Reports have shown that SARS-CoV-2 can be passed through fecal matter, with one study finding that 48.1% of COVID-19 patients expressed viral SARS-CoV-2 mRNA in their stool. Given that the GI tract is a target tissue affected by COVID-19, this causes concern for those with underlying GI pathologies, such as inflammatory bowel disease (IBD). Regrettably, there have been only limited studies on the impact of COVID-19 on gut health, and the impact of COVID-19 on intestinal inflammation among IBD patients remains unclear. In particular, questions regarding susceptibility to SARS-CoV-2 infection, clinical impact of COVID-19 on IBD, and the potential influence of age, sex, and immunosuppressant medications are still poorly understood. An improved understanding of these issues is needed to address the unique risks of COVID-19 among IBD patients, as well as the potential impact of SARS-CoV-2 on the host intestinal microbiota.