《e生命》：COVID-19患者存在血栓风险

编辑翻译：奇奇

译文校对：菁菁

本文献于2021年3月首次发表在最新的《e生命》（eLife）期刊上。文献中研究人员发现，COVID-19患者的持续性免疫反应会引发血栓以及并发症。

一项发表在《e生命》上的研究表明，某些COVID-19治愈者会因血栓引发严重的并发症，像心脏病发作和中风，这可能是由治愈后血管内持续性免疫反应引起的。

导致COVID-19的SARS-CoV-2病毒。

这些发现可能有助于解释COVID-19治愈者的持续性症状的原因，或者说明为什么有些治愈者会在几周或者几个月后出现中风和心脏病发作。这些发现也启发了有助于阻止这些并发症的潜在策略。

“在感染的最初阶段，导致COVID-19的SARS-CoV-2病毒可能攻击血管内壁，从而引起炎症和免疫反应，并在短期内导致血管损伤。”论文第一作者、南洋理工大学李光前医学院（LKCMedicine）研究助理Florence Chioh解释道，“本研究中，我们想要调查从长期看COVID-19治愈者的血管内会发生什么。”

Chioh和他的同事从康复出院一个月内的COVID-19治愈者身上收集了血液样本。他们发现，与健康者相比，COVID-19治愈者血液内漂浮的受损血管细胞数量（循环内皮细胞）是健康者的2倍。在患有高血压或者糖尿病等疾病的治愈者的血液内，研究人员发现了更多的受损血管细胞，这些疾病也会对血管产生损害。

除了血管受损的迹象外，研究小组发现治愈者体内有大量炎性蛋白，这些蛋白是由免疫细胞产生的细胞因子。尽管实际上病毒已不存在，他们还是发现了异常高数量的免疫细胞，这些是有助于消灭病毒的T细胞。

Chioh说：“我们发现，过度活跃的免疫系统可能是引起一些COVID-19治愈者血管损伤的原因。这可能会导致血管‘渗漏’，增加血栓的风险。”

Christine Cheung是论文的资深作者，也是LKCMedicine的医学助理教授兼教务主席。他说：“我们的研究表明，COVID-19患者能够从康复后的密切监测中受益，尤其是那些患有慢性疾病的患者。这将有助于确定可能需要血液稀释剂或者预防疗法的高风险人群，避免他们受到凝血并发症的伤害。”

英语原文

Prolonged Immune Response May Contribute to Post-COVID-19 Blood Clots

Serious complications due to blood clots, such as heart attacks and strokes, that are experienced by some COVID-19 survivors may be caused by a lingering immune response in the blood vessels after recovery, suggests a study published in eLife.

The findings may help explain why some COVID-19 survivors, so-called ‘long-haulers’, report lasting COVID-19 symptomsor why some experience strokes or heart attacks weeks or months after recovery. They may also suggest potential strategies to help prevent these complications.

"During the initial stages of infection, SARS-CoV-2, the virus that causes COVID-19, may attack the lining of the blood vessels which can trigger inflammation and an immune response. This can result in blood vessel damage in the short term," explains first author Florence Chioh, Research Assistant at the Lee Kong Chian School of Medicine (LKCMedicine), Nanyang Technological University, Singapore. " For our study, we wanted to investigate what happens in the blood vessels of COVID-19 survivors over the longer term."

Chioh and colleagues collected blood samples from COVID-19 survivors within a month of their recovery and discharge from the hospital. They found that, in comparison with healthy individuals, COVID-19 survivors have twice as many damaged blood vessel cells, called circulating endothelial cells, floating in their blood. Even more of these damagedblood vessel cells were found in survivors who had conditions such as hypertension or diabetes that can also damage the blood vessels.

In addition to signs of blood vessel damage, the team found that survivors had an abundance of inflammatory proteins called cytokines that are produced by immune cells. They also found unusually high numbers of immune cells called T cells, which help destroy viruses, despite the fact that the virus was already gone.

"We show that an overactive immune system is the likely cause of blood vessel damage seen in some COVID-19 survivors," Chioh says. "This may cause ‘leakiness’ in the blood vessels that increases the risk of blood clots."

"Our work suggests that COVID-19 patients, especially those with underlying chronic conditions, may benefit from close post-recovery monitoring," adds senior author Christine Cheung, Assistant Professor and Provost's Chair in Medicine at LKCMedicine. "This would help identify high-risk individuals who may need blood thinners or preventative therapy to protect them from debilitating blood-clotting complications."

参考文献

Florence WJ Chioh et al, Convalescent COVID-19 patients are susceptible to endothelial dysfunction due to persistent immune activation, eLife (2021). DOI: 10.7554/eLife.64909

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