肠道微生物群是COVID-19辅助治疗的目标吗?

K. Hilpert
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引用次数: 1

摘要

跨膜蛋白血管紧张素I转换酶2(ACE2)和跨膜丝氨酸蛋白酶2(TMPRSS2)在胃肠道中的高表达导致严重急性呼吸系统综合征冠状病毒2型的感染,前者是肺部的100多倍。根据荟萃分析数据,9.8-20%的新冠肺炎患者出现胃肠道症状,其中腹泻最为常见,约50%的患者通过粪便传播高滴度病毒,报告了首次粪便传播。此外,新冠肺炎患者的不同研究表明,肠道炎症、肠道损伤和肠道粘膜完整性减弱会导致通透性增加。这会导致炎症和菌血症的增加。低粘膜完整性和低肠道损伤是疾病进展和进入重症监护室(ICU)的良好预测指标。几项试点研究表明,与健康对照组相比,新冠肺炎患者的肠道微生物组发生了变化,微生物丰富度和多样性较低,可导致菌血症的机会性病原体富集。在这些患者中,很大一部分患者出院时生态失调没有得到解决,一项研究表明,新冠肺炎后3个月,生态失调仍然存在。因此,新冠肺炎患者肠道微生物组的生态失调与慢性新冠肺炎综合征(CCS)之间可能存在联系。各种临床试验正在调查益生菌对急性新冠肺炎患者的益处,其中大多数尚未报告结果。然而,两项临床试验表明,某种益生菌组合对急性新冠肺炎患者有益且安全。益生菌治疗组的死亡率为11%,对照组为22%。此外,益生菌组的症状清除得更快,患呼吸衰竭的风险降低了8倍。总之,有证据表明,新冠肺炎患者出现肠道炎症、通透性增加和微生物组微生态失调,从而为急性和慢性新冠肺炎的辅助治疗提供了新的靶点。这方面还需要更多的研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Is the Gut Microbiome a Target for Adjuvant Treatment of COVID-19?
High expression of the transmembrane protein angiotensin I converting enzyme 2 (ACE2), more than 100-times higher as in the lung, and transmembrane serine protease 2 (TMPRSS2) in the gastrointestinal tract leads to infection with SARS-CoV-2. According to meta-analysis data, 9.8–20% of COVID-19 patients experience gastrointestinal symptoms, where diarrhoea is the most frequent, and about 50% shed viruses with high titre through their faeces, where a first faecal transmission was reported. Furthermore, gut inflammation, intestinal damage, and weakening of the gut mucosal integrity that leads to increased permeability has been shown in different studies for COVID-19 patients. This can lead to increased inflammation and bacteraemia. Low mucosal integrity combined with low intestinal damage is a good predictor for disease progression and submission to the intensive care unit (ICU). Several pilot studies have shown that the gut microbiome of COVID-19 patients is changed, microbial richness and diversity were lower, and opportunistic pathogens that can cause bacteraemia were enriched compared to a healthy control group. In a large proportion of these patients, dysbiosis was not resolved at discharge from the hospital and one study showed dysbiosis is still present after 3 months post COVID-19. Consequently, there might be a link between dysbiosis of the gut microbiome in COVID-19 patients and chronic COVID-19 syndrome (CCS). Various clinical trials are investigating the benefit of probiotics for acute COVID-19 patients, the majority of which have not reported results yet. However, two clinical trials have shown that a certain combination of probiotics is beneficial and safe for acute COVID-19 patients. Mortality was 11% for the probiotic treatment group, and 22% for the control group. Furthermore, for the probiotic group, symptoms cleared faster, and an 8-fold decreased risk of developing a respiratory failure was calculated. In conclusion, evidence is arising that inflammation, increased permeability, and microbiome dysbiosis in the gut occur in COVID-19 patients and thus provide new targets for adjuvant treatments of acute and chronic COVID-19. More research in this area is needed.
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