SARS-CoV-2再感染:增加动脉粥样硬化性心血管疾病患者功能失调内皮的损伤

IF 1.4 Q3 PERIPHERAL VASCULAR DISEASE
Petri T. Kovanen , Alpo Vuorio
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引用次数: 0

摘要

在这篇简短的叙述性综述中,我们旨在确定内皮功能障碍在观察到的新冠肺炎相关心血管疾病风险上升中的病理生理作用。严重急性呼吸系统综合征冠状病毒2型病毒的变异株已经导致了几波新冠肺炎疫情,新的变异株和亚变异株很可能出现并迅速传播。根据一项大型队列研究,严重急性呼吸系统综合征冠状病毒2型再次感染的发病率约为0.66/10000人周。首次感染和再次感染严重急性呼吸系统综合征冠状病毒2型都会增加心脏事件的风险,尤其是在有心血管危险因素和伴随的系统内皮功能障碍的易感患者中。通过恶化预先存在的内皮功能障碍,首次感染和随后的新冠肺炎再次感染都可能使内皮促凝和促血栓形成,并最终导致局部血栓形成。当发生在心外膜冠状动脉中时,急性冠状动脉综合征的风险增加,而当发生在心肌微血管中时,会发生分散性心肌损伤,这两种情况都会使新冠肺炎患者出现不良心血管后果。总之,考虑到对新出现的严重急性呼吸系统综合征冠状病毒2亚型的心血管风险再感染的保护减弱,建议在新冠肺炎患者患病期间及其后使用他汀类药物治疗,部分原因是他汀类药物往往会减少内皮功能障碍。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

SARS-CoV-2 reinfection: Adding insult to dysfunctional endothelium in patients with atherosclerotic cardiovascular disease

SARS-CoV-2 reinfection: Adding insult to dysfunctional endothelium in patients with atherosclerotic cardiovascular disease

In this short narrative review, we aim at defining the pathophysiological role endothelial dysfunction in the observed COVID-19–associated rise in risk of cardiovascular disease. Variants of the SARS-CoV-2 virus have caused several epidemic waves of COVID-19, and the emergence and rapid spread of new variants and subvariants are likely. Based on a large cohort study, the incidence rate of SARS-CoV-2 reinfection is about 0.66 per 10 000 person-weeks. Both the first infection and reinfection with SARS-CoV-2 increase cardiac event risk, particularly in vulnerable patients with cardiovascular risk factors and the accompanying systemic endothelial dysfunction. By worsening pre-existing endothelial dysfunction, both the first infection and reinfection with ensuing COVID-19 may turn the endothelium procoagulative and prothrombotic, and ultimately lead to local thrombus formation. When occurring in an epicardial coronary artery, the risk of an acute coronary syndrome increases, and when occurring in intramyocardial microvessels, scattered myocardial injuries will ensue, both predisposing the COVID-19 patients to adverse cardiovascular outcomes. In conclusion, considering weakened protection against the cardiovascular risk-enhancing reinfections with emerging new subvariants of SARS-CoV-2, treatment of COVID-19 patients with statins during the illness and thereafter is recommended, partly because the statins tend to reduce endothelial dysfunction.

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来源期刊
Atherosclerosis plus
Atherosclerosis plus Cardiology and Cardiovascular Medicine
CiteScore
2.60
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66 days
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