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1.Department of Orthopaedics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
2.Zhejiang University School of Medicine, Hangzhou 310058, China
3.Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310005, China
4.Department of Nuclear Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
5.Department of Orthopaedics, Third Xiangya Hospital, Central South University, Changsha 410013, China
6.Department of Orthopaedic Physical Therapy, Faculty of Physical Therapy, Nahda University, Beni Suef 2711860, Egypt
7.Republic Scientific Practical Center of Neurology and Neurosurgery, Ministry of Health of the Republic of Belarus, Minsk 220004, Belarus
收稿日期:2023-07-21,
修回日期:2024-01-01,
网络出版日期:2025-02-19,
纸质出版日期:2025-04-23
姚成俊,董延钊,周海英等.COVID-19和急性肢体缺血:病理生理学和分子机制的最新假说[J].浙江大学学报(英文版)(B辑:生物医学和生物技术),2025,26(04):333-352.
Chengjun YAO, Yanzhao DONG, Haiying ZHOU, et al. COVID-19 and acute limb ischemia: latest hypotheses of pathophysiology and molecular mechanisms[J]. Journal of zhejiang university-science b (biomedicine & biotechnology), 2025, 26(4): 333-352.
姚成俊,董延钊,周海英等.COVID-19和急性肢体缺血:病理生理学和分子机制的最新假说[J].浙江大学学报(英文版)(B辑:生物医学和生物技术),2025,26(04):333-352. DOI: 10.1631/jzus.B2300512.
Chengjun YAO, Yanzhao DONG, Haiying ZHOU, et al. COVID-19 and acute limb ischemia: latest hypotheses of pathophysiology and molecular mechanisms[J]. Journal of zhejiang university-science b (biomedicine & biotechnology), 2025, 26(4): 333-352. DOI: 10.1631/jzus.B2300512.
2019冠状病毒病(COVID-19)作为一种多系统疾病,可导致各种严重并发症。急性肢体缺血(ALI)被认为是与COVID-19相关的一种并发症,通常预示着不良预后。但目前人们对COVID-19相关ALI的病理生理和分子机制仍知之甚少,高凝状态和血栓形成被认为是重要机制。本文强调了血管痉挛、缺氧和酸中毒在疾病发病中的作用,血管紧张素转化酶2(ACE2)途径、炎症和血小板激活可能是COVID-19诱导上述病理变化的重要分子机制。此外,本文从遗传、年龄和性别角度对COVID-19相关ALI危险因素的假说进行了讨论和分析,并对治疗方法如使用白细胞介素-6(IL-6)拮抗剂托珠单抗、钙通道拮抗剂和血管紧张素转化酶抑制剂等进行总结,以期为治疗冠状病毒相关肢体缺血性疾病提供新见解。
Coronavirus disease 2019 (COVID-19) is a multi-system disease that can lead to various severe complications. Acute limb ischemia (ALI) has been increasingly recognized as a COVID-19-associated complication that often predicts a poor prognosis. However
the pathophysiology and molecular mechanisms underlying COVID-19-associated ALI remain poorly understood. Hypercoagulability and thrombosis are considered important mechanisms
but we also emphasize the roles of vasospasm
hypoxia
and acidosis in the pathogenesis of the disease. The angiotensin-converting enzyme 2 (ACE2) pathway
inflammation
and platelet activation may be important molecular mechanisms underlying these pathological changes induced by COVID-19. Furthermore
we discuss the hypotheses of risk factors for COVID-19-associated ALI from genetic
age
and gender perspectives based on our analysis of molecular mechanisms. Additionally
we summarize therapeutic approaches such as use of the interleukin-6 (IL-6) blocker tocilizumab
calcium channel blockers
and angiotensin-converting enzyme inhibitors
providing insights for the future treatment of coronavirus-associated limb ischemic diseases.
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