Rigid respiration: fulminant pulmonary fibrosis after COVID-19.

Rigid respiration: fulminant pulmonary fibrosis after COVID-19.
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DOI:
10.1016/j.ebiom.2022.104428
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发表时间:
2023-01
期刊:
影响因子:
11.1
通讯作者:
Meyerholz DK
Meyerholz DK
中科院分区:
医学1区
文献类型:
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作者:
Meyerholz DK

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2019年冠状病毒病(COVID-19)是由严重急性呼吸道综合征冠状病毒-2(SARS-CoV-2)引起的感染,这是一种新型的人畜共患冠状病毒。2019冠状病毒病人类病例于2019年底在中国武汉附近首次发现,但感染迅速蔓延至地球仪各地,并于2020年仅数月后被世界卫生组织宣布为大流行病。1,2大多数感染SARS-CoV-2的个体具有轻微的临床过程,具有常见的感冒样呼吸道症状,并且临床累及其他器官系统并不罕见。对于严重COVID-19感染的个体,肺部疾病是一种常见的病理特征,可进展为急性呼吸窘迫综合征(ARDS),这与住院、重症监护室入院、机械通气甚至死亡有关。2,3 COVID-19的急性临床表现通常是明确的,但在初次感染和后续再感染后幸存者中出现的急性后后遗症越来越多地被记录和认可。4,5在急性后遗症的范围内,肺纤维化是一种主要的并发症,其中肺功能下降可能需要肺移植或成为死亡的一个促成因素。当异常胶原沉积在细胞外基质中时,发生肺纤维化,这导致缺乏常规呼吸所需的顺应性(“拉伸性”)的僵硬肺。COVID-19后肺纤维化(PCPF)的报告与符合严重疾病的临床因素相关性更高,包括:较高的肺部CT评分、ICU入院、机械通气和住院时间。第六章病态
Coronavirus disease of 2019 (COVID-19) is an infection caused by severe acute respiratory syndromecoronavirus-2 (SARS-CoV-2), a novel, zoonotic coronavirus. COVID-19 cases in humans were first recognized near Wuhan China in late 2019, but the infection rapidly spread around the globe and was declared a pandemic by the World Health Organization only a few months later in 2020. 1, 2 Most individuals infected by SARS-CoV-2 have a mild clinical course with common cold-like respiratory tract symptoms and clinical involvement in other organ systems is not uncommon. For individuals with severe COVID-19 infection, lung disease is a common pathological feature that can progress to acute respiratory distress syndrome (ARDS) and this is associated with hospitalization, intensive care unit admission, mechanical ventilation and even mortality. 2, 3 Acute clinical manifestations of COVID-19 are generally well-defined, but the emergence of post-acute sequelae in survivors following primary infection and sequential reinfection are increasingly documented and recognized. 4, 5Within the spectrum of post-acute sequelae, pulmonary fibrosis is a major complication where diminished lung function can require lung transplantation or be a contributing factor to mortality. 5 Pulmonary fibrosis occurs when aberrant collagens are deposited in the extracellular matrix and this results in a rigid lung that lacks the compliance (" stretchability") needed for routine respiration. Reports of post-COVID-19 pulmonary fibrosis (PCPF) are more associated with clinical factors consistent with severe disease including: higher lung CT scores, ICU admission, mechanical ventilation and length of hospitalization. 6 The patho-
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