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为什么近50%新冠患者出院1年后还有后遗症？Nature: 新冠重症引发自身抗体攻击

2021-09-17 网络 网络

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近期，国内原本已控制住的新冠疫情卷土重来。

近期，国内原本已控制住的新冠疫情卷土重来。
 
自9月10日，莆田仙游县发现本土病例以来，截止9月15日24时，莆田相关疫情累计报告病例204例，其中确诊病例200例，无症状感染者4例。
 
                                              福建进行的大规模新冠病毒检测。
                                                     图片来源：新华社
随着疫苗的普及，有数据统计，在八月期间，我国新冠感染者的重症发生比例约为2%。
                                                                                          重症的标准
在之前我们写的一篇文章中提到，对于住院的新冠患者，将近有一半的人在康复出院1年后还仍然有后遗症。（柳叶刀：武汉最大规模数据！近半数新冠患者1年后还有后遗症）
 
为什么对于重症患者，在康复一年以后，仍然还伴有后遗症呢？
 
9月14日，斯坦福医学院在《自然通讯》发表了一篇文章，文章分析了重症新冠患者与自身抗体之间的关系。该研究表明，重症住院的新冠患者更容易产生自身抗体（autoantibody），出现这种自身抗体可能就是自身免疫疾病的预兆。
 
自身抗体：自身抗体是指针对自身组织，器官、细胞及细胞成分的抗体。自身免疫疾病中有很多自身抗体。在体内，如果自身抗体过多，则会攻击自身的健康组织，从而对身体造成损害。
 
在这项研究员中，于2020年3、4月期间，科学家们分别在3个大学附属医院共抽取了147名新冠感染病人的血液，又在加利福尼亚的凯撒医疗（Kaiser Permanente）抽取了48名新冠感染病人的血液。
 
科学家们以这些血液样本为实验组，以新冠前捐助的血液样品为对照组，测量血液样品中的抗体水平。
 
他们检测了样品中的几种不同的抗体水平，包括针对病毒的抗体、自身抗体、直接针对细胞因子和蛋白的抗体（这些细胞因子和蛋白为免疫细胞所分泌，用于互相协作整体调控免疫系统）。
 
结果发现，在住院的新冠患者中，至少有60%的患者携带抗细胞因子的抗体，而在健康对照组中携带抗细胞因子抗体的仅约15%。
 
Utz说，重症患者携带的抗细胞因子抗体的比例更高，可能是因为病毒感染时间较长，因此导致免疫系统过度发挥作用。在免疫系统发挥作中的过程中，大量的细胞因子可能会刺激产生抗细胞因子抗体，但是这种抗细胞因子在抗击新冠中没有效果，或者会对自身造成伤害。
 
同时，如果这些自身抗体阻挡了细胞因子与受体的结合，下游的免疫细胞可能就无法激活。结果就是，病毒有更多的时间复制，最终导致患者的结局更差。
 
研究者们对50名患者的血液样品进行分析，并检测了其中的自身抗体水平。
                                                                   图片来源：Nature
 
结果发现，在入院的第一周，约20%的患者产生了新的自身抗体。在很多病例中，这种自身抗体与我们在自身免疫疾病中见到的自身抗体其实非常相似。
 
在一些病例中，之所以能够检测出新抗体，其实可能是因为该抗体数量增加了。原本，体内抗体数量非常少，所以无法检测出。同时，由于数量少，因此很可能对身体并不会产生伤害。但是，现在由于新冠感染，患者免疫应答，导致抗体数量大量增加，所以可以被检测出了。
 
在其他的一些病例中，可能是因为免疫系统首次见到了病毒的某种组成部分，而这些组成部分与我们自身蛋白的结构非常相似，因而机体产生了针对自身蛋白的自身抗体。
 
对于原因，作者给出猜测：在新冠感染控制的很差的患者体内，病毒游荡很久，免疫系统得以持续把病毒分解成碎片。因此免疫细胞看到了新冠病毒的一些碎片，而这些碎片与自身的蛋白很相近，因此免疫系统产生了自身抗体。
 
这一发现也支持了接种疫苗的必要性。目前的新冠疫苗，无论是含有SARS-CoV-2病毒的一种蛋白（刺突蛋白，英文Spike protein，又叫S蛋白)，还是含有合成这种蛋白的mRNA，人体接触后，免疫系统都不会见到大量的其他类的病毒蛋白，因此也就不会被迷惑而产生自身抗体了。
 
还有，疫苗所产生的免疫炎症反应也要比真正的感染弱很多，因此免疫系统没那么容易被迷惑而产生针对自身组织的抗体。所以，打过疫苗的患者，更可能针对刺突蛋白快速产生免疫反应，从而不会产生自身抗体。
 
最近一篇发在Nature上的一篇文章也提到新冠疫苗（辉瑞）并不会导致可检查出来的自身抗体。
 

Systems vaccinology of the BNT162b2 mRNA vaccine in humans

斯坦福医学院的风湿与免疫学家PJ Utz说：如果新冠的症状非常严重，导致不得不住院，那么即便从新冠中康复，也未必能彻底摆脱后遗症。
 
Utz 说，“如果你还没打疫苗，并且侥幸认为‘大部分人即便在得了新冠后貌似也没事，所以不用打疫苗’，这种想法存在一个不可控因素，那就是，你并不确定自己会是轻症还是重症。如果是重症，那么病毒可能诱骗你的自身免疫，这会带来终身的麻烦”。
 
“我们并不是说你一定会得自身免疫病，因为现在还没有长期试验，不知道自身抗体在一两年后是否还会存在，不过目前看来其长期存在是有可能的。
 
所以为什么不打疫苗，而去冒这个没有必要的风险呢？”
 
Utz 已计划要进一步研究无症状或轻症的新冠病人的血液样品。等到试验结果出来，我们就可以判断出到底是什么原因导致产生自身抗体。仅仅是因为SARS-CoV-2病毒蛋白与人体自身蛋白的相似性吗？还是因为重症患者的免疫系统过度活跃呢？
 
资料来源：
1. Study links severe COVID-19 to increase in self-attacking antibodies. By Stanford University Medical Center. Available at https://medicalxpress.com/news/2021-09-links-severe-covid-self-attacking-antibodies.html
2. Study shows why second dose of COVID-19 vaccine shouldn't be skipped. By Stanford University Medical Center. Available at https://medicalxpress.com/news/2021-07-dose-covid-vaccine-shouldnt.html
3. 新冠数据信息来自国家卫生健康委员会官方网站
4. Xie W, Zhu S, Liu Y, et al. Nan Fang Yi Ke Da Xue Xue Bao. 2020;40(8):1112-1118. doi:10.12122/j.issn.1673-4254.2020.08.07
5. 医家卫生健康委.新型冠状病毒肺炎诊疗方案(试行第七版)[EB/ OL]. <a href="http://www.nhc.gov.cn/yzygj/s7653p/202003/46c9294a7dfe4cef80dc7f5912eb1989/files/ce3e6945832a438eaae415350a8ce964.pdf" target="_blank">http://www.nhc.gov.cn/yzygj/s7653p/202003/46c9294a7dfe4cef80dc7f5912eb1989/files/ce3e6945832a438eaae415350a8ce964.pdf</a>.

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    2022-02-01 liye789132251

    #Nat#

    0

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    2021-11-17 tidiq

    #新冠患者#

    0

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    2021-09-19 huirong

    #后遗症#

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1885391, encodeId=7ab7188539139, content=<a href='/topic/show?id=3b2112532d8' target=_blank style='color:#2F92EE;'>#Nat#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12532, encryptionId=3b2112532d8, topicName=Nat)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2e6f107, createdName=liye789132251, createdTime=Tue Feb 01 10:19:59 CST 2022, time=2022-02-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1906561, encodeId=38f219065612d, content=<a href='/topic/show?id=317e5805e9d' target=_blank style='color:#2F92EE;'>#新冠患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=58057, encryptionId=317e5805e9d, topicName=新冠患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b3e9205, createdName=tidiq, createdTime=Wed Nov 17 04:19:59 CST 2021, time=2021-11-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1418810, encodeId=12e01418810a4, content=<a href='/topic/show?id=da8839121bb' target=_blank style='color:#2F92EE;'>#后遗症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39121, encryptionId=da8839121bb, topicName=后遗症)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=615b3422729, createdName=huirong, createdTime=Sun Sep 19 00:19:59 CST 2021, time=2021-09-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1052402, encodeId=02f6105240204, content=学习，希望早日特效药, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e8212476654, createdName=1244c0ebm28暂无昵称, createdTime=Fri Sep 17 20:53:29 CST 2021, time=2021-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1052585, encodeId=ad021052585cf, content=新冠肺炎，疫情何时才能消失, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=公卫新人, createdTime=Fri Sep 17 12:19:59 CST 2021, time=2021-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1052303, encodeId=c73010523033d, content=是如果新冠的症状非常严重，导致不得不住院，那么即便从新冠中康复，, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/08/02/7354b3539aae6a0ccb1e0fff04c12084.jpg, createdBy=205b1984786, createdName=随梦飞扬, createdTime=Fri Sep 17 12:18:50 CST 2021, time=2021-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1052276, encodeId=5baa10522e6d0, content=不错的分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210427/b594a756d77e4171b5313e531ef89b43/31c000a8a97d4872b698c80fb8a33369.jpg, createdBy=624b2152505, createdName=大叔默默路过, createdTime=Fri Sep 17 10:31:31 CST 2021, time=2021-09-17, status=1, ipAttribution=)]
    2021-09-17 1244c0ebm28暂无昵称

    学习，希望早日特效药

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1885391, encodeId=7ab7188539139, content=<a href='/topic/show?id=3b2112532d8' target=_blank style='color:#2F92EE;'>#Nat#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12532, encryptionId=3b2112532d8, topicName=Nat)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2e6f107, createdName=liye789132251, createdTime=Tue Feb 01 10:19:59 CST 2022, time=2022-02-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1906561, encodeId=38f219065612d, content=<a href='/topic/show?id=317e5805e9d' target=_blank style='color:#2F92EE;'>#新冠患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=58057, encryptionId=317e5805e9d, topicName=新冠患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b3e9205, createdName=tidiq, createdTime=Wed Nov 17 04:19:59 CST 2021, time=2021-11-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1418810, encodeId=12e01418810a4, content=<a href='/topic/show?id=da8839121bb' target=_blank style='color:#2F92EE;'>#后遗症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39121, encryptionId=da8839121bb, topicName=后遗症)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=615b3422729, createdName=huirong, createdTime=Sun Sep 19 00:19:59 CST 2021, time=2021-09-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1052402, encodeId=02f6105240204, content=学习，希望早日特效药, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e8212476654, createdName=1244c0ebm28暂无昵称, createdTime=Fri Sep 17 20:53:29 CST 2021, time=2021-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1052585, encodeId=ad021052585cf, content=新冠肺炎，疫情何时才能消失, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=公卫新人, createdTime=Fri Sep 17 12:19:59 CST 2021, time=2021-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1052303, encodeId=c73010523033d, content=是如果新冠的症状非常严重，导致不得不住院，那么即便从新冠中康复，, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/08/02/7354b3539aae6a0ccb1e0fff04c12084.jpg, createdBy=205b1984786, createdName=随梦飞扬, createdTime=Fri Sep 17 12:18:50 CST 2021, time=2021-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1052276, encodeId=5baa10522e6d0, content=不错的分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210427/b594a756d77e4171b5313e531ef89b43/31c000a8a97d4872b698c80fb8a33369.jpg, createdBy=624b2152505, createdName=大叔默默路过, createdTime=Fri Sep 17 10:31:31 CST 2021, time=2021-09-17, status=1, ipAttribution=)]
    2021-09-17 公卫新人

    新冠肺炎，疫情何时才能消失

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1885391, encodeId=7ab7188539139, content=<a href='/topic/show?id=3b2112532d8' target=_blank style='color:#2F92EE;'>#Nat#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12532, encryptionId=3b2112532d8, topicName=Nat)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2e6f107, createdName=liye789132251, createdTime=Tue Feb 01 10:19:59 CST 2022, time=2022-02-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1906561, encodeId=38f219065612d, content=<a href='/topic/show?id=317e5805e9d' target=_blank style='color:#2F92EE;'>#新冠患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=58057, encryptionId=317e5805e9d, topicName=新冠患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b3e9205, createdName=tidiq, createdTime=Wed Nov 17 04:19:59 CST 2021, time=2021-11-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1418810, encodeId=12e01418810a4, content=<a href='/topic/show?id=da8839121bb' target=_blank style='color:#2F92EE;'>#后遗症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39121, encryptionId=da8839121bb, topicName=后遗症)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=615b3422729, createdName=huirong, createdTime=Sun Sep 19 00:19:59 CST 2021, time=2021-09-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1052402, encodeId=02f6105240204, content=学习，希望早日特效药, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e8212476654, createdName=1244c0ebm28暂无昵称, createdTime=Fri Sep 17 20:53:29 CST 2021, time=2021-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1052585, encodeId=ad021052585cf, content=新冠肺炎，疫情何时才能消失, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=公卫新人, createdTime=Fri Sep 17 12:19:59 CST 2021, time=2021-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1052303, encodeId=c73010523033d, content=是如果新冠的症状非常严重，导致不得不住院，那么即便从新冠中康复，, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/08/02/7354b3539aae6a0ccb1e0fff04c12084.jpg, createdBy=205b1984786, createdName=随梦飞扬, createdTime=Fri Sep 17 12:18:50 CST 2021, time=2021-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1052276, encodeId=5baa10522e6d0, content=不错的分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210427/b594a756d77e4171b5313e531ef89b43/31c000a8a97d4872b698c80fb8a33369.jpg, createdBy=624b2152505, createdName=大叔默默路过, createdTime=Fri Sep 17 10:31:31 CST 2021, time=2021-09-17, status=1, ipAttribution=)]
    2021-09-17 随梦飞扬

    是如果新冠的症状非常严重，导致不得不住院，那么即便从新冠中康复，

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1885391, encodeId=7ab7188539139, content=<a href='/topic/show?id=3b2112532d8' target=_blank style='color:#2F92EE;'>#Nat#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12532, encryptionId=3b2112532d8, topicName=Nat)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2e6f107, createdName=liye789132251, createdTime=Tue Feb 01 10:19:59 CST 2022, time=2022-02-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1906561, encodeId=38f219065612d, content=<a href='/topic/show?id=317e5805e9d' target=_blank style='color:#2F92EE;'>#新冠患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=58057, encryptionId=317e5805e9d, topicName=新冠患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b3e9205, createdName=tidiq, createdTime=Wed Nov 17 04:19:59 CST 2021, time=2021-11-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1418810, encodeId=12e01418810a4, content=<a href='/topic/show?id=da8839121bb' target=_blank style='color:#2F92EE;'>#后遗症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39121, encryptionId=da8839121bb, topicName=后遗症)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=615b3422729, createdName=huirong, createdTime=Sun Sep 19 00:19:59 CST 2021, time=2021-09-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1052402, encodeId=02f6105240204, content=学习，希望早日特效药, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e8212476654, createdName=1244c0ebm28暂无昵称, createdTime=Fri Sep 17 20:53:29 CST 2021, time=2021-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1052585, encodeId=ad021052585cf, content=新冠肺炎，疫情何时才能消失, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=公卫新人, createdTime=Fri Sep 17 12:19:59 CST 2021, time=2021-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1052303, encodeId=c73010523033d, content=是如果新冠的症状非常严重，导致不得不住院，那么即便从新冠中康复，, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/08/02/7354b3539aae6a0ccb1e0fff04c12084.jpg, createdBy=205b1984786, createdName=随梦飞扬, createdTime=Fri Sep 17 12:18:50 CST 2021, time=2021-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1052276, encodeId=5baa10522e6d0, content=不错的分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210427/b594a756d77e4171b5313e531ef89b43/31c000a8a97d4872b698c80fb8a33369.jpg, createdBy=624b2152505, createdName=大叔默默路过, createdTime=Fri Sep 17 10:31:31 CST 2021, time=2021-09-17, status=1, ipAttribution=)]
    2021-09-17 大叔默默路过

    不错的分享

    0