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Does inflammation link stress to poor COVID-19 outcome?
Stress & Health ( IF 4.1 ) Pub Date : 2020-12-14 , DOI: 10.1002/smi.3017 Steven J Lamontagne 1, 2 , Diego A Pizzagalli 2 , Mary C Olmstead 1, 3
Stress & Health ( IF 4.1 ) Pub Date : 2020-12-14 , DOI: 10.1002/smi.3017 Steven J Lamontagne 1, 2 , Diego A Pizzagalli 2 , Mary C Olmstead 1, 3
Affiliation
Coronavirus disease 2019 (COVID-19) continues to ravage communities across the world. Despite its primary effect on the respiratory system, the virus does not solely impact those with underlying lung conditions as initially predicted. Indeed, prognosis is worsened (often fatal) in patients with pre-existing hyperinflammatory responses (e.g., hypertension, obesity and diabetes), yet the mechanisms by which this occurs are unknown. A number of psychological conditions are associated with inflammation, suggesting that these may also be significant risk factors for negative outcomes of COVID-19. In this review, we evaluate preclinical and clinical literature suggesting that chronic stress-induced hyperinflammation interacts synergistically with COVID-19-related inflammation, contributing to a potentially fatal cytokine storm syndrome. In particular, we hypothesize that both chronic stress and COVID-19-related hyperinflammation are a product of glucocorticoid insufficiency. We discuss the devastating effects of SARS-CoV-2 on structural and functional aspects of the biological stress response and how these induce exaggerated inflammatory responses, particularly interleukin (IL)-6 hypersecretion. We postulate that chronic stress should be considered a significant risk factor for adverse COVID-19-related health outcomes, given overlapping peripheral and central immune dysregulation in both conditions. We conclude by discussing how people with a history of chronic stress could mitigate their risk for COVID-19 complications, identifying specific strategies that can be implemented during self-isolation.
中文翻译:
炎症是否将压力与糟糕的 COVID-19 结果联系起来?
2019 年冠状病毒病 (COVID-19) 继续肆虐世界各地的社区。尽管它对呼吸系统有主要影响,但该病毒并不仅仅像最初预测的那样影响那些有潜在肺部疾病的人。事实上,预先存在高炎症反应(例如,高血压、肥胖和糖尿病)的患者的预后会恶化(通常是致命的),但发生这种情况的机制尚不清楚。许多心理状况与炎症有关,这表明这些也可能是 COVID-19 负面结果的重要危险因素。在这篇综述中,我们评估了临床前和临床文献,表明慢性压力引起的过度炎症与 COVID-19 相关炎症协同相互作用,导致潜在的致命细胞因子风暴综合征。特别是,我们假设慢性压力和 COVID-19 相关的过度炎症都是糖皮质激素不足的产物。我们讨论了 SARS-CoV-2 对生物应激反应的结构和功能方面的破坏性影响,以及这些影响如何引起过度的炎症反应,尤其是白细胞介素 (IL)-6 分泌过多。鉴于两种情况下外周和中枢免疫失调重叠,我们假设慢性压力应被视为与 COVID-19 相关的不良健康结果的重要风险因素。我们最后讨论了有慢性压力史的人如何降低 COVID-19 并发症的风险,确定可以在自我隔离期间实施的具体策略。
更新日期:2020-12-14
中文翻译:
炎症是否将压力与糟糕的 COVID-19 结果联系起来?
2019 年冠状病毒病 (COVID-19) 继续肆虐世界各地的社区。尽管它对呼吸系统有主要影响,但该病毒并不仅仅像最初预测的那样影响那些有潜在肺部疾病的人。事实上,预先存在高炎症反应(例如,高血压、肥胖和糖尿病)的患者的预后会恶化(通常是致命的),但发生这种情况的机制尚不清楚。许多心理状况与炎症有关,这表明这些也可能是 COVID-19 负面结果的重要危险因素。在这篇综述中,我们评估了临床前和临床文献,表明慢性压力引起的过度炎症与 COVID-19 相关炎症协同相互作用,导致潜在的致命细胞因子风暴综合征。特别是,我们假设慢性压力和 COVID-19 相关的过度炎症都是糖皮质激素不足的产物。我们讨论了 SARS-CoV-2 对生物应激反应的结构和功能方面的破坏性影响,以及这些影响如何引起过度的炎症反应,尤其是白细胞介素 (IL)-6 分泌过多。鉴于两种情况下外周和中枢免疫失调重叠,我们假设慢性压力应被视为与 COVID-19 相关的不良健康结果的重要风险因素。我们最后讨论了有慢性压力史的人如何降低 COVID-19 并发症的风险,确定可以在自我隔离期间实施的具体策略。