Neurological infection with SARS-CoV-2 - the story so far.

Neurological infection with SARS-CoV-2 - the story so far.
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DOI:
10.1038/s41582-020-00453-w
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发表时间:
2021-03
期刊:
Nature reviews. Neurology
影响因子:
--
通讯作者:
Solomon T
Solomon T
中科院分区:
其他
文献类型:
--
作者:
Solomon T

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随着COVID-19大流行的发展和神经系统表现的报道,人们越来越担心SARS-CoV-2可能直接侵入神经细胞。然而,一年来针对这一问题的研究揭示了一个不同的故事,其中心是炎症过程。嗅觉丧失、脑病和中风是与SARS-CoV-2感染相关的最常见的神经系统综合征,尽管已经报道了许多其他综合征。对人类活检样本的分析表明,嗅觉丧失主要是由于SARS-CoV-2感染嗅上皮和嗅球中的非神经元细胞,导致局部炎症和神经元功能障碍。高比例的COVID-19重症监护室患者出现谵妄,证据表明这是由微血管和炎症机制引起的。尸检数据显示,COVID-19中星形胶质细胞和小胶质细胞活化,特别是在脑干中,那里也有细胞毒性T细胞浸润。SARS-CoV-2可以通过PCR和免疫组织化学在大脑中检测到,但迄今为止的证据表明它主要存在于血管和免疫细胞中,而不是直接感染神经元。
As the COVID-19 pandemic developed and neurological manifestations were reported, concern grew that SARS-CoV-2 might directly invade neuronal cells. However, research throughout the year to address this concern has revealed a different story with inflammatory processes at its centre. Anosmia, encephalopathy and stroke are the most common neurological syndromes associated with SARS-CoV-2 infection, though many others have been reported. Analysis of human biopsy samples suggests that anosmia results predominantly from SARS-CoV-2 infection of non-neuronal cells in the olfactory epithelium and olfactory bulb, leading to local inflammation and neuronal malfunction. A high proportion of patients admitted to intensive care units with COVID-19 develop delirium, and evidence suggests that this is caused by microvascular and inflammatory mechanisms. Autopsy data show activation of astrocytes and microglia in COVID-19, particularly in the brainstem, where there is also infiltration of cytotoxic T cells. SARS-CoV-2 can be detected in the brain with PCR and immunohistochemistry, but the evidence to date suggests it is mostly in vascular and immune cells rather than directly infecting neurons.
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