肥胖与新型冠状病毒肺炎病毒:易感?伴随?  

Obesity:a Facilitator or a Bystander for COVID-19

作　　者：彭佳佳 张利莉[1] PENG Jia-Jia;ZHANG Li-Li(Department of Endocrinology and Metabolism,The Second Affiliated Hospital of Chongqing Medical University,Chongqing 400010,China)

机构地区：[1]重庆医科大学附属第二医院内分泌代谢科,重庆400010

出　　处：《中国生物化学与分子生物学报》2021年第10期1314-1318,共5页Chinese Journal of Biochemistry and Molecular Biology

摘　　要：新型冠状病毒肺炎(corona virus disease 2019,COVID-19)肆虐全球,由于缺乏有效的疫苗及抗病毒疗法,多国医疗卫生系统面临着沉重的压力。COVID-19在人体内主要通过血管紧张素转换酶-2(angiotensin converting enzyme-2,ACE-2)作用,故ACE-2是严重急性呼吸综合征冠状病毒2型进入宿主细胞的关键受体,而脂肪组织中ACE-2的表达水平高于肺组织,可能增加肥胖病人对该病毒的易感性。肥胖相关的慢性低度炎症、维生素D缺乏及肠道菌群失调会削弱免疫反应,使机体更容易受到感染,对疫苗、抗病毒药物和抗菌药物的反应更弱。肥胖导致的慢性炎症和纤溶功能受损会增加血栓形成的风险,可能导致病人肺损伤恶化和死亡。肥胖相关的并发症,例如血脂异常、2型糖尿病、高血压和心血管疾病等将是肥胖COVID-19病人发生严重并发症的危险因素。肥胖病人通常会出现低通气和睡眠呼吸暂停综合征,最终导致低氧血症和肺动脉高压。另外,重度肥胖病人在通气支持、血管通路和褥疮性皮肤破裂方面也面临着重要的挑战。因此,肥胖可能是COVID-19感染和严重程度的高危因素。但是,也有COVID-19疾病的队列研究提示,COVID-19病人的肥胖比率并不高于普通人群的肥胖比率,因此肥胖本身也可能只是COVID-19感染的伴随因素。另有研究显示,与正常体重病人相比,肥胖病人发生急性呼吸窘迫综合征后的死亡率更低。因此,适度肥胖也可能有助于提高重症病人生存率。基于此,本文就有关肥胖病人是否易感COVID-19相关进展及潜在机制做一综述。With corona virus disease 2019(COVID-19)raging around the world,healthcare systems in many countries are under severe strain due to the lack of an effective vaccine or antiviral therapy.COVID-19 is mainly activated by angiotensin converting enzyme-2(ACE-2)in human,so ACE-2 is the key receptor for severe acute respiratory syndrome coronavirus 2 to enter host cells.The expression level of ACE-2 in adipose tissues is higher than that in lung tissues,which may increase the susceptibility of obese patients to the virus.Chronic low-grade inflammation,vitamin D deficiency and intestinal flora imbalance associated with obesity can weaken the immune response,making the immune system more susceptible to infection and less responsive to vaccines,antivirals and antibiotics.Chronic inflammation and impaired fibrinolysis caused by obesity increase the risk of thrombosis,which may lead to deteriorating lung damage and patient deaths.Obesity-related complications such as dyslipidemia,type 2 diabetes,hypertension,and cardiovascular diseases may be risk factors for complications in obese COVID-19 patients.Obese patients commonly develop hypoventilation and sleep apnea syndromes,which eventually leads to hypoxemia and pulmonary hypertension.In addition,severe obese patients face significant management challenges in ventilator support,vascular access,and management of bedsore skin ruptures.Therefore,obesity may be a high risk factor for COVID-19 infection and severity.However,some COVID-19 cohort studies suggested that the obesity rate of COVID-19 patients is usually no higher than that of the general population,so obesity may only be an accompanying factor for COVID-19 infection.In addition,studies have shown that compared with normal weight people,obese patients have a lower mortality rate after acute respiratory distress syndrome,so moderate obesity may also improve survival in critically ill patients.Based on this,the review mainly aims to discuss the progress and potential mechanisms of COVID-19 susceptibility in obese patients

关 键 词：肥胖 新型冠状病毒 血管紧张素转换酶-2 

分 类 号：R589[医药卫生—内分泌]