코로나 바이러스가 호흡기 이외의 장기에 주는 영향들

모르는 단어

clot: 혈관이 막히는 것

 

 

After only a few days caring for critically ill COVID-19 patients at the start of the outbreak in New York City, Aakriti Gupta, MD, realized that this was much more than a respiratory disease.

 I observed that patients were clotting a lot, they had high blood sugars even if they did not have diabetes, and many were experiencing injury to their hearts and kidneys," 

In early March, there wasn't much clinical guidance on the non-respiratory effects of COVID-19, so Gupta decided to coalesce findings from studies that were just beginning to appear in the literature with what the physicians were learning from experience.

Their review—the first extensive review of COVID-19's effects on all affected organs outside the lungs—was published today in Nature Medicine.

"Physicians need to think of COVID-19 as a multisystem disease," Gupta says. "There's a lot of news about clotting but it's also important to understand that a substantial proportion of these patients suffer kidney, heart, and brain damage, and physicians need to treat those conditions along with the respiratory disease."

Scientists think these clotting complications may stem from the virus's attack on cells that line the blood vessels. When the virus attacks blood vessel cells, inflammation increases, and blood begins to form clots, big and small. These blood clots can travel all over the body and wreak havoc on organs, perpetuating a vicious cycle of thromboinflammation.

The untempered inflammation can also overstimulate the immune system, and though doctors initially shied away from using steroids to globally suppress the immune system, a recent clinical trial has found that at least one steroid, dexamethasone, reduced deaths in ventilated patients by one-third. Randomized clinical trials are underway to target specific components of thromboinflammation and the immune system, such as interleukin-6 signaling.

Clots can cause heart attacks, but the virus attacks the heart in other ways, one author says.

"The mechanism of heart damage is currently unclear, as the virus has not been frequently isolated from the heart tissue in autopsy cases," says Gupta.

The heart muscle may be damaged by systemic inflammation and the accompanying cytokine release, a flood of immune cells that normally clears up infected cells but can spiral out of control in severe COVID-19 cases.

The ACE2 receptor used by the virus to gain entry into the cells is found in high concentrations in the kidney and could likely be responsible for the renal damage.

Neurological symptoms, including headache, dizziness, fatigue, and loss of smell, may occur in about a third of patients.

 

코로나 바이러스가 호흡기 이외의 장기에 주는 영향들을 정리한 내용이다.

콩팥, 혈관이 막히는 것, 심장에 영향을 주었다고 한다. 자세한 내용은 논문 참고.

 

reference

Aakriti Gupta et al, Extrapulmonary manifestations of COVID-19, Nature Medicine (2020). DOI: 10.1038/s41591-020-0968-3