How does SARS-CoV-2 targets the elderly patients? A review on potential mechanisms increasing disease severity.
How does SARS-CoV-2 targets the elderly patients? A review on potential mechanisms increasing disease severity.
复制标题
DOI：
10.1016/j.ejim.2020.11.024
复制
发表时间：
2021-01
影响因子：
8
通讯作者：
Muller M
中科院分区：
文献类型：
--
作者：
Smorenberg A;Peters EJ;van Daele P;Nossent EJ;Muller M
特别是体弱的老年人，严重的COVID-19人数很多。老年患者的病毒脱落可能增加。由于非典型的疾病表现，早期识别是复杂的。在认知障碍患者中实施卫生措施具有挑战性。心肺储备下降，增加并发症的风险。衰老的免疫系统具有促炎倾向，被SARS-CoV-2夸大了。重要性：在COVID-19病例中，尤其是（虚弱）老年人，严重感染、住院、并发症和死亡的数量很高。死亡率最高的年龄是80至89岁。为什么这些患者患重症COVID-19的风险更高？在这篇叙述性综述中，我们讨论了有关病毒传播、身体储备和免疫系统的潜在机制，增加了老年患者感染的严重程度。观察：首先，COVID-19的传播可能在老年患者中增强。病毒脱落可能会增加，由于非典型疾病表现和有限的检测能力，早期识别可能会变得复杂。实施卫生和检疫措施，特别是对痴呆等认知障碍患者，可能具有挑战性。此外，老年患者的心肺储备下降，更可能有并发症，包括动脉粥样硬化，使他们更容易发生并发症。衰老的先天和适应性免疫系统被削弱，同时存在促炎倾向。SARS-CoV-2对免疫系统细胞因子产生和T细胞的影响似乎进一步加剧了这种促炎倾向，特别是在心血管合并症患者中，增加了疾病的严重程度。结论和相关性：上述所有因素的组合有助于老年患者COVID-19的疾病严重程度。虽然需要在老年患者中进行更大规模的COVID-19研究，但了解增加疾病严重程度的因素可能会改善护理和预防措施，以保护未来面临（严重）COVID-19风险的老年患者。
Especially the frail elderly show a high number of severe COVID-19. Viral shedding may be increased in elderly patients. Early identification is complicated due to atypical disease presentation. Applying hygiene measures in patients with cognitive disorders is challenging. The cardiorespiratory reserve is decreased increasing the risk of complications. The aging immune system has a pro-inflammatory tendency, exaggerated by SARS-CoV-2. Importance: Among COVID-19 cases, especially the (frail) elderly show a high number of severe infections, hospital admissions, complications, and death. The highest mortality is found between 80 and 89 years old. Why do these patients have a higher risk of severe COVID-19? In this narrative review we address potential mechanisms regarding viral transmission, physical reserve and the immune system, increasing the severity of this infection in elderly patients. Observations: First, the spread of COVID-19 may be enhanced in elderly patients. Viral shedding may be increased, and early identification may be complicated due to atypical disease presentation and limited testing capacity. Applying hygiene and quarantine measures, especially in patients with cognitive disorders including dementia, can be challenging. Additionally, elderly patients have a decreased cardiorespiratory reserve and are more likely to have co-morbidity including atherosclerosis, rendering them more susceptible to complications. The aging innate and adaptive immune system is weakened, while there is a pro-inflammatory tendency. The effects of SARS-CoV-2 on the immune system on cytokine production and T-cells, further seem to aggravate this pro-inflammatory tendency, especially in patients with cardiovascular comorbidity, increasing disease severity. Conclusions and relevance: The combination of all factors mentioned above contribute to the disease severity of COVID-19 in the older patient. While larger studies of COVID-19 in elderly patients are needed, understanding the factors increasing disease severity may improve care and preventative measures to protect the elderly patient at risk for (severe) COVID-19 in the future.
登录
查看更多内容
危及生命的Covid-19患者中针对I型IFN的自身抗体。
DOI：
10.1126/science.abd4585
发表时间：
2020-10-23
期刊：
Science (New York, N.Y.)
影响因子：
--
作者：
Bastard P;Rosen LB;Zhang Q;Michailidis E;Hoffmann HH;Zhang Y;Dorgham K;Philippot Q;Rosain J;Béziat V;Manry J;Shaw E;Haljasmägi L;Peterson P;Lorenzo L;Bizien L;Trouillet-Assant S;Dobbs K;de Jesus AA;Belot A;Kallaste A;Catherinot E;Tandjaoui-Lambiotte Y;Le Pen J;Kerner G;Bigio B;Seeleuthner Y;Yang R;Bolze A;Spaan AN;Delmonte OM;Abers MS;Aiuti A;Casari G;Lampasona V;Piemonti L;Ciceri F;Bilguvar K;Lifton RP;Vasse M;Smadja DM;Migaud M;Hadjadj J;Terrier B;Duffy D;Quintana-Murci L;van de Beek D;Roussel L;Vinh DC;Tangye SG;Haerynck F;Dalmau D;Martinez-Picado J;Brodin P;Nussenzweig MC;Boisson-Dupuis S;Rodríguez-Gallego C;Vogt G;Mogensen TH;Oler AJ;Gu J;Burbelo PD;Cohen JI;Biondi A;Bettini LR;D'Angio M;Bonfanti P;Rossignol P;Mayaux J;Rieux-Laucat F;Husebye ES;Fusco F;Ursini MV;Imberti L;Sottini A;Paghera S;Quiros-Roldan E;Rossi C;Castagnoli R;Montagna D;Licari A;Marseglia GL;Duval X;Ghosn J;HGID Lab;NIAID-USUHS Immune Response to COVID Group;COVID Clinicians;COVID-STORM Clinicians;Imagine COVID Group;French COVID Cohort Study Group;Milieu Intérieur Consortium;CoV-Contact Cohort;Amsterdam UMC Covid-19 Biobank;COVID Human Genetic Effort;Tsang JS;Goldbach-Mansky R;Kisand K;Lionakis MS;Puel A;Zhang SY;Holland SM;Gorochov G;Jouanguy E;Rice CM;Cobat A;Notarangelo LD;Abel L;Su HC;Casanova JL
通讯作者：
Casanova JL
影响因子：
6.3
作者：
Giovannini S;Onder G;Liperoti R;Russo A;Carter C;Capoluongo E;Pahor M;Bernabei R;Landi F
通讯作者：
Landi F
影响因子：
8.8
作者：
Granados, Andrea;Peci, Adriana;Gubbay, Jonathan B.
通讯作者：
Gubbay, Jonathan B.
DOI：
10.1164/ajrccm.163.4.9909121
发表时间：
2001-03-01
影响因子：
24.7
作者：
Ho, JC;Chan, KN;Tsang, KW
通讯作者：
Tsang, KW
影响因子：
15.9
作者：
Chen, Guang;Wu, Di;Ning, Qin
通讯作者：
Ning, Qin