Japanese

Title	COVID-19に伴う全身性炎症反応性微小血管内皮症 (systemic inflammatory-reactive microvascular endotheliopathy, SIRME) の一論考 : 循環器病予防と新型コロナウイルス感染症
Subtitle	特別寄稿
Authors	東條美奈子*1,2
Authors (kana)
Organization	*1北里大学医療衛生学部 リハビリテーション学科, *2北里大学大学院医療系研究科 循環器内科学 / 機能回復学
Journal	日本循環器病予防学会誌
Volume	55
Number	2
Page	73-86
Year/Month	2020 / 9
Article	報告
Publisher	日本循環器病予防学会
Abstract	「要約」新型コロナウイルス感染症(the new coronavirus disease 2019:COVID-19)パンデミックは私たちの生活を根本的に変えてしまった. 今後も続いていくであろう「new-normal with corona(コロナと共存する新常態)」の時代を生き抜いていくためには, これまでの先人の多くの叡智を集約し, より高次の視点から本感染症の病態を深く理解し, コロナ禍においてより鮮明化した医療を含めた社会的な問題点を1つ1つ改善していくことが必要である. 本稿では, COVID-19の病態生理において鍵を握ると考えられる微小血管内皮障害に着目し, これまでに得られている知見をまとめ, 本メカニズムのCOVID-19重症化の予防や診断・治療への関与について論じる. 高血圧, 糖尿病, 肥満, 循環器疾患などの患者において, COVID-19による死亡率が高いことが報告されている. また高齢者や喫煙者ではCOVID-19が重症化しやすいことも明らかになっている. これらの危険因子は血管内皮機能を低下させることが知られており, いずれも循環器病予防における重要なターゲットである. 一方で, 全身をめぐる血管内皮細胞を覆う細胞外マトリックスである血管内皮グリコカリックスはこれらの危険因子によって障害される. さらにCOVID-19の原因ウイルスであるsevere acute respiratory syndrome coronavirus 2(SARS-CoV-2)はヒトの肺胞上皮や小腸だけでなく, 血管内皮細胞や血管平滑筋細胞に豊富に発現するangiotensin-converting enzyme 2(ACE2)受容体に結合することから, COVID-19を悪化させるメカニズムに血管内皮グリコカリックスが重要な働きを担っている可能性が示唆される. 重症COVID-19によって引き起こされる, 急性呼吸窮迫症候群(acute respiratory distress syndrome:ARDS), 播種性血管内凝固(disseminated intravascular coagulation:DIC), 川崎病ショック症候群, 敗血症などの重篤な病態においては, 可溶性血管内皮グリコカリックスの血中濃度が異常高値となることが多数報告されており, より高値の症例においては全身性血栓塞栓症や多臓器不全を引き起こしやすいことが知られている. 循環器病予防のための取り組みや疾病管理対策は, COVID-19重症化予防やパンデミック時の医療体制堅持などの観点からも非常に重要であることが明らかになりつつある. 将来を見据えた, より広義での循環器病予防活動は, 今後, 迫りくるであろう第二波, 第三波のCOVID-19重症化予防策としても有効な武器になり得るものと期待している.
Practice	公衆衛生学
Keywords	SARS-CoV-2, サイトカイン・ストーム, ARDS, 川崎病, 危険因子, 循環器疾病管理, cytokine storm, acute respiratory distress syndrome, Kawasaki disease, risk, factor, cardiovascular disease management

English

Title	A note on systemic inflammatory-reactive microvascular endotheliopathy (SIRME) : Prevention of cardiovascular disease and COVID-19
Subtitle	Special Contribution
Authors	Minako Yamaoka-Tojo*1,2
Authors (kana)
Organization	*1Department of Rehabilitation, Kitasato University School of Allied Health Sciences, *2 Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences
Journal	Japanese Journal of Cardiovascular Disease Prevention
Volume	55
Number	2
Page	73-86
Year/Month	2020 / 9
Article	Report
Publisher	The Japanese Society of Cardiovascular Disease Prevention
Abstract	The new coronavirus disease 2019 (COVID-19) pandemic has fundamentally changed our lives. To survive in the era of "new-normal with corona" that will continue in the foreseeable, it is necessary to deeply understand the pathophysiology of the infectious disease to improve various social problems, including cardiovascular disease management, during the COVID-19 pandemic. In this review, the author focuses on microvascular endothelial damage, which is the key to the pathophysiology of COVID-19, proposes a new concept called "systemic inflammatory-reactive microvascular endotheliopathy (SIRME)" induced by COVID-19, and presents a definition for SIRME. High mortality rates have been reported in patients with hypertension, diabetes, obesity, and cardiovascular disease who were infected with COVID-19. The disease also is more likely to become severe in elderly people and smokers. These risk factors are known to reduce vascular endothelial function, and all are important targets in cardiovascular disease prevention. On the other hand, vascular endothelial glycocalyx, an extracellular matrix that covers vascular endothelial cells throughout the body, is impaired by these risk factors. Furthermore, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is the causative virus of COVID-19, binds to the angiotensin-converting enzyme 2 receptor, which is abundantly expressed in vascular endothelial cells and vascular smooth muscle cells as well as in human alveolar epithelium and small intestine. Vascular endothelial glycocalyx may have an important role in the mechanism that exacerbates COVID-19. Under severe conditions, such as acute respiratory distress syndrome, disseminated intravascular coagulation, Kawasaki disease shock syndrome, and sepsis caused by severe COVID-19, circulating levels of soluble vascular endothelial glycocalyx are dramatically increased. It is known that systemic thromboembolism and multiple organ failure are likely to occur in patients with a high level of fragmented circulating vascular endothelial glycocalyx. It is becoming clear that efforts to prevent cardiovascular disease and implement disease control measures are very important from the perspective of lessening the severity of COVID-19 and not overwhelming health care systems during a pandemic. We anticipate that a broader set of cardiovascular disease prevention activities will need to be established as preventive measures against COVID-19 aggravation in the second and third pandemic waves that will soon be approaching.
Practice	Public Health
Keywords	SARS-CoV-2, cytokine storm, acute respiratory distress syndrome, Kawasaki disease, risk, factor, cardiovascular disease management

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