Recent Developments in the Pathogenesis of COVID-19-associated Myocarditis

doi:10.12114/j.issn.1007-9572.2021.00.524

Abstract

Abstract: Severe acute respiratory syndrome coronavirus-2（SARS-CoV-2）was initially thought to mainly affect the respiratory system.A growing body of research has found that SARS-CoV-2 infection can affect multiple human organ systems，and heart is a major target organ secondary to lung.COVID-19-associated cardiac injury is often seen clinically，about 1%-7% of which is myocarditis.COVID-19-associated myocarditis often has a poor outcome.However，the possible pathogenesis mechanisms of COVID-19-associated cardiac injury，and its progression to COVID-19-associated myocarditis，as well as related pathophysiological changes are still unknown.Available data analysis has revealed that the recognized mechanism of cardiac injury in COVID-19 is ACE2-mediated cardiac injury，and cytokine storm-mediated or immune-mediated cardiac injury is only suggestive currently.Due to limited use of cardiac MRI and endocardial biopsy as well as insufficient autopsy findings and other basic research data in patients with COVID-19-associated myocarditis，the diagnosis and treatment of COVID-19-associated myocarditis are challenges that still exist for clinicians.We reviewed the possible pathophysiological mechanisms of COVID-19-associated myocarditis，which will contribute to improving medical workers' understanding of this disease so that its related mortality may be reduced.

Key words: COVID-19, SARS-CoV-2, Myocarditis, Myocardial injury, Pathogenesis, Review

摘要： 严重急性呼吸综合征冠状病毒2（SARS-CoV-2）最初被认为主要对呼吸系统产生影响，随着研究深入，目前已经发现SARS-CoV-2感染会影响人体的多个器官系统，心脏是继肺部感染之后的一大目标靶器官。临床上经常能观察到新型冠状病毒肺炎（COVID-19）患者的心脏损伤，其中心肌炎在COVID-19心肌损伤中占1%~7%，这类患者临床预后常较差。令人遗憾的是，目前COVID-19是如何引起心肌损伤，又是如何进展为心肌炎，其相关机制及病理生理改变目前仍未知。从目前资料分析发现，除血管紧张素转换酶2（ACE2）介导打击机制较为学者认可外，细胞因子风暴及免疫介导引发心肌损伤等机制目前仍是推测性的，鉴于心脏MRI、心内膜活检的应用受限，而COVID-19相关心肌炎的尸检等基础研究资料较少，因此，COVID-19相关心肌炎的诊断及治疗对临床医生而言仍是一大挑战。本文就COVID-19相关心肌炎可能存在的病理生理机制予以综述，以期有助于增进医务人员对该病的认识进而降低总体死亡率。

关键词: 新型冠状病毒肺炎, 新型冠状病毒, 心肌炎, 心肌损伤, 发病机制, 综述

LUO Fei,LI Shuren,HAO Xiao, et al. Recent Developments in the Pathogenesis of COVID-19-associated Myocarditis　[J]. Chinese General Practice, 2021, 24(20): 2589-2593. DOI: 10.12114/j.issn.1007-9572.2021.00.524.
罗飞,李树仁,郝潇等. 新型冠状病毒肺炎相关心肌炎发病机制的研究进展[J]. 中国全科医学, 2021, 24(20): 2589-2593. DOI: 10.12114/j.issn.1007-9572.2021.00.524.

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