Cov tsos mob ntawm lub raum tuaj yeem tshwm sim ntawm COVID-19
Mar 23, 2022
ali.ma@wecistanche.com
Abstract
Kab mob khaus laus nas vais lav 2019 (COVID-19) tau ua rau muaj kev sib kis loj thoob ntiaj teb. Cov neeg mob kis nrogCOVID-19 Feem ntau tshwm sim nrog cov tsos mob ua pa thiab mob ntsws. Cov tsos mob ntawm plab hnyuv kuj tuaj yeem tshwm sim hauv cov neeg mob no.Lub raumkev koom tes nthuav tawm raws li moblub rauminfarctthiab/los yog mob raum raug mob tau piav nyob rau hauv cov ntaub ntawv; Txawm li cas los xij, cov no feem ntau tshwm sim hauv cov neeg mob hnyavCOVID-19. Rau qhov zoo tshaj plaws ntawm peb txoj kev paub, tsis muaj cov xwm txheej qhia piav qhia txog qhov txawv txav ntawm lub raum pom kev pom hauv tus neeg mob uas tsuas yog daim ntawv me me.COVID-19. Yog li ntawd, peb tshaj tawm ib rooj plaub ntawm tus neeg mob meCOVID-19 nthuav tawm nrog mob plab thiab mob hnyavlub rauminfarct.
Ntsiab lus: xam tomography · Coronavirus kab mob ·Lub rauminfarct
Cistanche rau lub raum ua haujlwm
Taw qhia
Kab mob khaus laus nas vais lav 2019 (COVID-19) tau ua rau muaj kev sib kis loj thoob ntiaj teb. Tam sim no, tus naj npawb ntawm cov neeg mob tau tshaj 9,000,000. Cov neeg mob nrog COVID-19 feem ntau tshwm sim nrog cov tsos mob ua pa thiab mob ntsws [1, 2]. Tus kab mob no raug cais raws li hnyav rau cov neeg mob uas yog hypoxic thiab yuav tsum tau siv tshuab ua pa [3].
Cov tsos mob plab kuj tuaj yeem tshwm sim hauvCOVID-19 cov neeg mob. Cov ntaub ntawv tsis ntev los no los ntawm Wuhan tau tshaj tawm tias cov tsos mob plab hnyuv xws li raws plab tau tshwm sim hauv 79 feem pua ntawmCOVID-19 cov neeg mob [4]. Txawm li cas los xij, kev nthuav qhia kev kho mob ntawm cov neeg mob plab hnyuv tau raug tshaj tawm yav dhau los, txog niaj hnub no tsuas muaj qee qhov kev tshawb fawb piav qhia txog kev kuaj mob plab hauv cov neeg mob no. Hauv kev tshawb fawb tsis ntev los no, Bhayana et al. piav qhia txog kev mob plab hnyuv thiab cholestasis raws li kev kuaj mob plab feem ntau pom [5]. Tsis tas li ntawd, tsis muaj kev tshawb pom ntawm gastrointestinal,lub raumpathologies suav nroglub rauminfarct kuj tau tshaj tawm [6–12]. Txawm li cas los xij,lub raumKev tshawb pom feem ntau pom hauv cov neeg mob hnyavCOVID-19 kab mob. Rau qhov zoo tshaj plaws ntawm peb txoj kev paub, tsis muaj cov ntaub ntawv tshaj tawm uas piav qhia qhov txawv txavlub raumpom nyob rau hauv ib tug neeg mob nrog ib tug me me daim ntawv ntawm covCOVID-19 kab mob.
Ntawm no peb nthuav qhia ib rooj plaub me meCOVID-19 nrog txawv txavlub raumKev tshawb pom ntawm xam tomography (CT).
Case report
Ib tug txiv neej muaj hnub nyoog {{0}} tus neeg mob uas muaj hnub nyoog tau qhia rau peb lub tsev kawm ntawv uas muaj cov tsos mob kub taub hau (38 degree) thiab mob plab rau 4 hnub. Nws tsis muaj cov tsos mob ua pa thiab tsis pom qhov txawv txav ntawm nws qhov kev kuaj lub cev thiab tsis muaj keeb kwm ntawm kev ua pa. Nws qhov kev ua haujlwm hauv chav kuaj pom pom leukopenia (3.8 × 10-3 µ / L) thiab lymphopenia (1.2 × 10-3 µ / L). Tsis tas li ntawd, cov kev ntsuas hauv qab no tau nce siab: d-dimer (0.7 µg / mL), lactate dehydrogenase (567 U / L), alanine aminotransferase (59 U / L), ferritin (577.8 ng / mL) thiab CRP (138.2 mg / L). Creatinine thiab e-GFR nyob rau hauv ib txwm txwv. Tus neeg mob raug xa mus rau lub tuam tsev kho mob hluav taws xob rau kev soj ntsuam ntxiv nrog kev sib piv-txhim kho lub hauv siab thiab lub plab CT. Lub hauv siab CT pom tau hais tias patchily, av-iav ib lobular opacities nrog reticular ntom ntawm lub peripheral feem ntawm ob lub ntsws (Fig. 1). Tsis tas li ntawd, ib qho rov qab halo kos npe tau tshwm sim nyob rau hauv lub posterior ntu ntawm sab xis sab sauv. Cov kev tshawb pom CT tau piav raws li qhov ua tau ntawm COVID{25}} kev tshawb pom. Tsis muaj cov cim qhia ntawm pulmonary arterial embolism. Nyob rau hauv lub plab mog CT, lub raum txoj cai pom patchily, sharply demarcated hypo txhim kho thiab tsis-txhim kho thaj chaw nyob rau hauv lub anterior ib feem ntawm lub qis ncej nrog nce heterogeneous linear ntom nyob rau hauv peri thiab pararenal cheeb tsam (Fig. 2). Tsis muaj lwm yam txawv txav tau pom ntawm lub plab CT. Raws li qhov tshwm sim ntawm kev kuaj mob thiab kev kuaj mob plab, segmentallub rauminfarct yog tus neeg mob txoj kev kuaj mob thiab nws tau mus rau peb lub tsev kho mob. Nyob rau hauv lub teeb ntawm lub hauv siab thiablub raumkev tshawb pom, ib qho kev sim tshuaj polymerase saw tshuaj tiv thaiv (PCR) los ntawm qhov ntswg qhov ntswg rau COVID-19 raug txiav txim thiab kuaj zis nrog kev kuaj kab mob zis. Kev kuaj PCR rov zoo rau tus kab mob COVID-19. Tsis muaj qhov txawv txav ntawm kev kuaj zis thiab zis kab lis kev cai tsis zoo. Tus neeg mob tsis tau tsim cov tsos mob ua pa thoob plaws hauv nws chav tsev kho mob thiab tsis tas yuav nkag mus rau chav saib xyuas mob hnyav. Nws raug kho nrog hydroxychloroquine thiab oseltamivir, raws li COVID-19 raws tu qauv ntawm peb lub zej zog lub chaw saib xyuas kev noj qab haus huv. Ntxiv rau, muab covlub raumKev tshawb pom ntawm CT thiab kev kuaj mob ntawmlub rauminfarct, tus neeg mob tau muab cov tshuaj uas tsis muaj molecular-yuag heparin. Tom qab hnub thib tsib ntawm kev kho mob, kub taub hau poob, thiab nws qhov mob plab zuj zus. Hnub 9 thiab 11 ntawm kev mus pw hauv tsev kho mob, qhov ntswg qhov ntswg rau kev kuaj PCR tau rov ua dua thiab cov txiaj ntsig tau hloov tsis zoo rau ob qho ntawm cov kev sim no. Tsis tas li ntawd, tag nrho nws cov tsos mob plab tau daws. Yog li ntawd, nws raug tso tawm thiab xa mus rau cais tawm hauv tsev.
Daim duab 1 Peripheral patchy av-iav peribronchovascular infiltrations yog tam sim no nrog reticular ntom nyob rau hauv ob lub ntsws lobes. Ib qho rov qab halo kos npe yog pom nyob rau hauv txoj cai ntsws, sab sauv-posterior ntu ( xub). Tsis muaj cov cim qhia ntawm thromboembolism hauv cov hlab ntsha loj
Fig. 2 Lub raum sab xis qhia tau hais tias muaj qhov sib txawv ntawm qhov sib txawv ntawm thaj chaw uas tsis muaj kev txhawb nqa thiab kev ua kom tsis zoo (xub xub). Tseem ceeb perinephric stranding kuj tseem muaj.
Cistanche tuaj yeem kho mob raum
Kev sib tham
Cov tsos mob plab hauv cov neeg mob nrogCOVID-19 Feem ntau feem ntau cuam tshuam nrog cov kab mob plab hnyuv thiab tuaj yeem tshwm sim hauv 16 feem pua -79 feem pua ntawm cov neeg mob [4, 5, 13]. Hla-sectional plab imaging tsis yog ib tug niaj hnub daim ntawv thov nyob rau hauvCOVID-19 cov neeg mob thiab feem ntau ua tau thaum tus neeg mob muaj mob plab thiab / lossis sepsis. Cov kev tshawb pom ntawm plab hnyuv loj tshaj plaws ntawm kev yees duab tau tshaj tawm raws li lub plab phab ntsa tuab thiab cholestasis [5].
Lub raumabnormalities nyob rau hauv cov neeg mob nrogCOVID-19 tau piav yav dhau los. Cov nolub raumpathologies suav nrogCOVID-19 cuam tshuam rau mob raum raug mob (AKI) [11] thiab muaj ob peb tsab ntawv ceeb toom piav qhialub rauminfarcts vim mob hypercoagulability xeev uas tuaj yeem tshwm sim hauv cov neeg mob no [5–9]. Lub xub ntiag ntawm AKI hauv cov neeg mob nrogCOVID-19 tau pom tias tsis tshua muaj teeb meem [11]. Hauv ib pawg los ntawm Tuam Tshoj nrog 1099COVID-19 cov neeg mob, tus nqi ntawm AKI yog 0.5 feem pua [14]. Cov txheej txheem ua tau ntawm AKI tau piav qhia nyob rau hauv peb txoj kev sib txawv raws li kev puas tsuaj cytokine, cov teebmeem hauv lub cev, thiab cov kabmob sib kis [11]. Su et al. qhia postmortem lub raum histopathological tsom xam ntawm 26 tus neeg mob, uas pom tau hais tias ntau yam ntawm histopathological tshawb pom [12]. Feem ntau cov pathology yog mob tubular necrosis vim endothelial puas tsuaj-ua rau microvascular lumen occlusion. Lawv tau piav qhia tias lawv cov txiaj ntsig tau nyob ntawm qhov ua tau rau lub raum kab mob nrogCOVID-19. Yog li, lawv xaus lus tias txawm nyob rau hauv cov neeg mob uas tsis tshua muaj mob hnyavCOVID-19 kab mob histopathologic hloov pauv kuj yuav pom [12]. Hauv cov neeg mob hnyavCOVID-19 mob ntsws, hypercoagulability-txog pathologies tau tshaj tawm. Hauv cov neeg mob no, qib ntawm d-dimer tau pom tias nyob rau theem siab [15, 16]. Spiez et al. pom tias lawv cov neeg kawm tau pom muaj hypercoagulopathy hnyav thiab lawv tau txuas cov txiaj ntsig no kom nce qib fibrinogen thiab ntau dhau fibrin polymerization los ntawmCOVID-19 kab mob [13]. Cov kws sau ntawv tau xaus lus tias microcirculation thrombosis, cov teeb meem ntawm cov hlab ntsha, thiab cov venous thromboembolic pathologies loj tuaj yeem pom nyob rau hauv cov neeg mob uas muaj ntau ntau d-dimer thiab ntev mus pw hauv tsev kho mob nrog kev kho cua sov ntev [15].
Hauv peb qhov xwm txheej, tus kab mob COVID-19 tau muab cais ua ib hom mob me me vim qhov kev tshawb pom ntawm kev kuaj mob thiab hluav taws xob.Lub raumCov kev tshawb pom tsis tau xav txog thiab tau kuaj pom qhov tshwm sim ntawm CT. Tsuas yog rau qhov mob plab, tsis muaj qhov tshwj xeeb pib kho mob lossis kuaj pom los qhia tias muaj cov kab mob hauv plab hauv plab. Cov kev tshawb pom ntawm plab CT tau xav tias sawv cev moblub rauminfarct thiab vim lub ntsws txawv txav, pom tus neeg mob tau kuaj pom tias muaj tus kab mob COVID-19. Muab qhov siab d-dimer qhov tseem ceeb, peb xav tias qhovlub raumKev tshawb pom tej zaum yuav tshwm sim los ntawm COVID-19 cov txheej txheem cuam tshuam ua rau AKI thiab/los yog hauv qab hypercoagulopathy. Txog niaj hnub no, tsuas muaj qee qhov xwm txheej qhia piav qhia txog kev tshawb pom lub raum thiab tag nrho cov xwm txheej no nyob ntawm qhov mob hnyav hypercoagulopathy [6-9]. Sib nrug los ntawm cov xwm txheej no, peb cov ntaub ntawv yog thawj zaug hauv cov ntaub ntawv nrog qhov txawv txav ntawm lub raum hluav taws xob pom tshwm sim hauv tus neeg mob uas tsuas yog mob me.COVID-19 thiab tsis muaj cov tsos mob ntawm thromboembolic pom nyob rau hauv lwm yam kabmob. Peb ntseeg tau tias qhov tshwm sim ntawm qhov mob plab hauv peb tus neeg mob tau tshwm sim los ntawm lub raum infarct vim muaj peev xwm ua rau endothelial puas tsuaj los ntawm microvascular puas tsuaj cuam tshuam nrog tus kab mob.
COVID-19 yog ib yam kab mob uas nquag ua rau mob ntsws thiab mob plab, tab sislub raumkev tshawb pom tseem tsis tau piav qhia dav dav. Hauv peb qhov xwm txheej, qhov tsis sib haum xeeb ntawm radiologic thiab kuaj kuaj pom yuav yog qhov tshwm sim ntawmlub raummicrovascular puas thiab infarct cuam tshuam rau COVID-19 kab mob. Kev kuaj radiologic yuav tsum tau ua nyob rau hauv cov neeg mob txawm tias muaj cov tsos mob plab tsis tseem ceeb. Txoj kev no tuaj yeem kuaj pom cov kev kuaj mob plab ntxiv, thiab qhov tsis paub txog ntawm COVID-19 tuaj yeem kuaj tau.
Nyiaj txiag
Tsis muaj nyiaj pab rau kab lus no.
Kev tsis sib haum xeeb
Cov kws sau ntawv tau tshaj tawm tias tsis muaj kev cuam tshuam ntawm kev txaus siab.
Kev pom zoo rau kev ncaj ncees
Tag nrho cov txheej txheem ua nyob rau hauv cov kev tshawb fawb uas muaj tib neeg cov neeg koom tau ua raws li cov qauv kev coj ncaj ncees ntawm lub koom haum thiab/lossis pawg neeg tshawb fawb hauv lub tebchaws thiab nrog rau xyoo 1964 Helsinki tshaj tawm thiab nws cov kev hloov kho tom qab lossis cov qauv kev coj ncaj ncees sib piv.
Cov ntaub ntawv pom zoo tau txais los ntawm txhua tus neeg koom nrog hauv txoj kev tshawb fawb.
Nyem rauCistanche para que sirve rau kev txhim kho raum ua haujlwm
Cov ntaub ntawv
1. Zhu N, Zhang D, Wang W, et al (2020) Tus kab mob coronavirus tshiab los ntawm cov neeg mob ntsws ntsws hauv Suav teb, 2019. N Engl J Med 382:727-733.
2. Wu, Z, McGoogan, JM (2020) Cov yam ntxwv ntawm thiab Cov Lus Qhia Tseem Ceeb Los Ntawm Tus Kab Mob Coronavirus 2019 (COVID-19) Kev tshwm sim hauv Suav teb: Cov ntsiab lus ntawm Daim Ntawv Qhia ntawm 72 314 Cov Neeg Mob Los ntawm Tuam Tsev Tuam Tshoj rau Kev Tswj thiab Tiv Thaiv Kab Mob. JAMA.
3. General Office of National Health Commission. Kev Ntsuas thiab Kev Kho Mob Pneumonia Infected by Novel Coronavirus (5th Trial Edition).
4. Tian Y, Rong L, Nian W, He Y (2020) Tshuaj xyuas kab lus: kab mob plab hnyuv hauv COVID-19 thiab muaj peev xwm kis tau cov quav. Alimentary Pharmology & Therapeutics, 51:843-851.
5. Bhayana R, Som A, Li MD, et al (2020) Abdominal Imaging Findings in COVID-19: Preliminary Observations. Radiology, 201908. Advance online publication.
6. Lushina N, Kuo JS, Shaikh HA (2020) Pulmonary, Cerebral, and Renal Thromboembolic Disease Associated with COVID-19 Kab mob. Radiology, 201623.
7. Xu JJ, Samaha D, Mondhe S, Massicotte-Azarniouch D, Knoll G, Ruzicka M (2020) Renal Infarct in a COVID-19 Tus neeg tau txais txiaj ntsig zoo raum-Pancreas Transplant. Am J Hloov
8. Farkash EA, Wilson AM, Jentzen JM (2020) Ultrastructural Evidence for Direct Renal Infection with SARS-CoV-2. J Am Soc Nephrol.
9. Tascón GC, Chiriboga DES, Ramos RL, et al (2020) Infarto renal en paciente con infección activa por COVID -19 [Renal infarction in a patient with active COVID -19 infection]. Nefrology.
10. Fanelli V, Fiorentino M, Cantaluppi V, Gesualdo L, Stallone G, Ronco C, Castellano G (2020) Acute raum raug mob hauv SARS-CoV-2 cov neeg mob. Critical Care (London, England), 24:155.
11. Ronco C, Reis T (2020) Kev cuam tshuam rau lub raum hauv COVID-19 thiab qhov laj thawj rau kev kho mob ntxiv. Nat Rev Nephrol. 16:308–310.
12. Su H, Yang M, Wan C, et al (2020) Renal histopathological analysis of 26 postmortem finds of patient with COVID-19 in China. Raum Int. S0085-2538(20)30369-0.
13. Luo S, Zhang X, Xu H (2020) Tsis txhob saib xyuas cov tsos mob ntawm plab zom mov hauv cov neeg mob uas muaj tus kab mob 2019 Novel Coronavirus (COVID-19). Clin Gastroenterol Hepatol. 18: 1636–1637.
14. Guan WJ, Ni ZY, Hu Y, et al (2020) Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 382: 1708–1720.
15. Spiezia L, Boscolo A, Poletto F, et al (2020) COVID-19-Txoj kev mob hnyav heev hauv cov neeg mob tau txais mus rau Chav Saib Xyuas Mob hnyav rau qhov mob ua pa tsis ua pa. Thromb Haemost. 120: 998-1000.
16. Tang N, Li D, Wang X, Sun Z (2020) Cov kab mob coagulation tsis zoo yog cuam tshuam nrog kev pom tsis zoo hauv cov neeg mob uas muaj tus kab mob ntsws tshiab. J Thromb Haemost 18:844-847.