基础医学与临床 ›› 2020, Vol. 40 ›› Issue (4): 433-439.

• 新型冠状病毒肺炎专题(1) •    下一篇

新型冠状病毒SARS-CoV-2: 高致病性及其防治

刘力*   

  1. 中国医学科学院基础医学研究所 北京协和医学院基础学院 病原学系, 北京 100005
  • 收稿日期:2020-03-05 修回日期:2020-03-07 出版日期:2020-04-05 发布日期:2020-04-06
  • 通讯作者: *lliu8@263.net
  • 基金资助:
    中国医学科学院创新工程(2017-I2M-3-007)

The novel coronavirus SARS-CoV-2: high pathogenecity and its prevention and therapy

LIU Li*   

  1. Department of Etiology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing 100005, China
  • Received:2020-03-05 Revised:2020-03-07 Online:2020-04-05 Published:2020-04-06
  • Contact: *lliu8@263.net

摘要: 冠状病毒曾被认为是一类在人群中不致病的或仅引起轻微自愈性疾病的病原体。但是,在人类在进入21世纪的前20年中,却经历了2002—2003年的SARS-CoV、2012年的MERS-CoV和2019—2020年的SARS-CoV-2三次冠状病毒的世界范围的流行。其中尤以最近这次大流行最为严重。截至2020年3月12日,已造成全球逾12.6万人感染,其中死亡超过4 600人。与前两次冠状病毒暴发相似,SARS-CoV-2也是经过跨物种传播由蝙蝠传给人类的,但中间宿主未知。与前两种冠状病毒相同,SARS-CoV-2也属于下呼吸道病原体,易感染有基础性疾病(如糖尿病、高血压等)的年长男性。重症以上患者除表现不同程度的呼吸障碍外,还可伴有消化道症状,甚至发生心脏及肾脏功能改变。病理检测发现,危重症患者肺脏常呈实质性改变,大量黏稠液体充斥气道导致呼吸困难。此外,淋巴细胞减少,C反应蛋白水平升高,大量炎性反应因子分泌导致细胞因子风暴,多脏器衰竭也是病情恶化重要指标。新冠肺炎患者间症状差别较大,需要根据患者的具体情况辨证施治;避免因治疗方法不当加重病情的进展,甚至导致患者死亡。本文将从新冠病毒的结构特点出发,对该病毒的来源、复制周期、致病性、发病特点及临床防治进行初步的回顾性综述。

关键词: 第二株SARS-冠状病毒, 2019冠状病毒疾病, 复制, 致死率, 发病率

Abstract: Coronavirus has been regarded as safe pathogen that causes no diseases or only induces milder syndromes. However, At the first 20 years as human society enters into the 21st century, the world has experienced three coronaviral epidemics(SARS-CoV in 2002—2003, MERS-CoV in 2012 and SARS-CoV-2 in 2019—2020) with the most severe in the latest one. By March 12, 2020, this outbreak has caused more than 126 000 confirmed cases with over 4 600 deaths. Similar with the previous two outbreaks, SARS-CoV-2 infection was also caused by cross species transmission that was believed to be derived from bats to human, although the intermediate hosts are still remained unknown. As the same as the previous two coronaviruses, SARS-CoV-2 also belongs to the pathogen that can infect lower respiratory tracts. Patients with underlying diseases such as diabetes and hypertension are more susceptible to this infection. The severe patients manifest not only different degrees of dyspnea, but also can sometimes develop functional damages in heart and/or kidney. The results of pathological autopsy indicated that the obstructive pulmonary ventilation failure in critical ill patients might be mainly due to the complete filling of excessive amount of viscous liquids in alveolar cavities and tracheas. Patients' conditions could be even worse when they develop the followings: lymphopenia, the increased level of CRP, cytokine storm caused by the large secretion of pro-inflammatory cytokines. Because of the quite differences in syndromes from patient to patient, diagnosis and treatment should be carefully evaluated and fully based on the illness as well as the patient’s condition so as to avoid improper treatments that might aggravate disease progression and even cause the deadweight loss in lives. This review attempts to summarize the current knowledge about the typical features of this novel coronavirus such as the structure of the viral genome, the origin of the virus, life cycle, morbidity, disease progression and the strategies of clinical prevention and treatments.

Key words: SARS-CoV-2, COVID-19, replication, mortality, morbidity

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