幾個(gè)月前您感染了新冠并康復(fù)了——但情況仍然不太好。當(dāng)你站起來(lái)時(shí)，你會(huì)感到頭暈，你的心跳加速。即使是日?，嵤乱矔?huì)讓您感到疲憊不堪。曾經(jīng)睡個(gè)好覺，也不再讓人感到神清氣爽。長(zhǎng)新冠，對(duì)吧？事情可能沒(méi)有那么簡(jiǎn)單。根據(jù)最近發(fā)表在《免疫學(xué)前沿》雜志上的一項(xiàng)研究，輕度甚至無(wú)癥狀的 新冠病例可能會(huì)導(dǎo)致您之前與某些病毒作斗爭(zhēng)的某些病毒庫(kù)重新激活，可能導(dǎo)致慢性疲勞綜合癥的癥狀——這種情況類似于長(zhǎng)期新冠。研究人員發(fā)現(xiàn)，像愛潑斯坦-巴爾這樣的皰疹病毒，單核細(xì)胞增多是背后的驅(qū)動(dòng)因素之一，它會(huì)在感染過(guò)新冠的未接種疫苗的患者中傳播。在慢性疲勞綜合征患者中，抗體反應(yīng)更強(qiáng)，表明免疫系統(tǒng)正在努力抵抗揮之不去的病毒。此類非新冠病原體已被指認(rèn)為慢性疲勞綜合征（也稱為肌痛性腦脊髓炎）的可能的罪魁禍?zhǔn)?。無(wú)緣由的模糊狀況導(dǎo)致出現(xiàn)疲勞、腦霧、走動(dòng)時(shí)頭暈和睡不醒等癥狀。專家說(shuō)，許多長(zhǎng)期新冠患者的癥狀可被描述為慢性疲勞綜合癥。研究人員在 10 月的研究中假設(shè)，新冠有時(shí)會(huì)導(dǎo)致免疫系統(tǒng)受到抑制，使因受到新冠壓力而重新激活的潛伏病毒重新循環(huán)——這些病毒與慢性疲勞綜合癥和長(zhǎng)新冠中常見的癥狀有關(guān)。
COVID isn’t just infecting you—it could be reactivating viruses that have been dormant in your body for years
You had COVID a few months ago and recovered—but things still aren’t quite right.When you stand up, you feel dizzy, and your heart races. Even routine tasks leave you feeling spent. And what was once a good night’s sleep no longer feels refreshing.Long COVID, right? It may not be so simple.A mild or even an asymptomatic case of COVID can cause reservoirs of some viruses you’ve previously battled to reactivate, potentially leading to symptoms of chronic fatigue syndrome—a condition that resembles long COVID, according to a recent study published in the journal Frontiers in Immunology. Researchers found herpes viruses like Epstein-Barr, one of the drivers behind mono, circulating in unvaccinated patients who had experienced COVID. In patients with chronic fatigue syndrome, antibody responses were stronger, signaling an immune system struggling to fight off the lingering viruses.Such non-COVID pathogens have been named as likely culprits behind chronic fatigue syndrome, also known as myalgic encephalomyelitis. The nebulous condition with no definitive cause leads to symptoms like fatigue, brain fog, dizziness when moving, and unrefreshing sleep.The symptoms of many long COVID patients could be described as chronic fatigue syndrome, experts say. Researchers in the October study hypothesized that COVID sometimes leads to suppression of the immune system, allowing latent viruses reactivated by the stress of COVID to recirculate—viruses linked to symptoms that are common in Chronic Fatigue Syndrome and long COVID.因此，在某些國(guó)家，“長(zhǎng)新冠”可能不是一個(gè)全新的存在，而是另一種病毒后疾病——就像埃博拉病毒、2003-2004 年最初的 SARS 和其他感染后的一些患者看到的疾病——與慢性疲勞綜合征重疊。正如美國(guó)頂級(jí)傳染病專家安東尼·福奇博士在 2020 年所說(shuō)，長(zhǎng)期新冠“很可能是與新冠相關(guān)的病毒后期綜合癥”。“我們?nèi)匀粵](méi)有這樣做”【指她的診所不檢查長(zhǎng)新冠患者的病毒再激活情況】約翰霍普金斯大學(xué)醫(yī)學(xué)院長(zhǎng)新冠診所的聯(lián)合主任Alba Miranda Azola博士告訴《財(cái)富》雜志，新冠有可能在至少一部分長(zhǎng)期新冠患者中重新激活潛伏病毒，導(dǎo)致慢性疲勞綜合癥癥狀。但她的診所不檢查長(zhǎng)新冠患者的病毒再激活情況。她不認(rèn)為這些病毒在患者身上引起癥狀的可能性值得給這些患者服用抗病毒藥物或抗生素，這可能導(dǎo)致不良副作用。“我們沒(méi)有足夠的證據(jù)支持這種治療，”她說(shuō)。阿佐拉補(bǔ)充說(shuō)，而其他為長(zhǎng)期新冠患者開過(guò)藥的醫(yī)生，這些患者并沒(méi)有看到太大的改善。她最近問(wèn)一位傳染病同事，在長(zhǎng)新冠患者中檢測(cè)和治療潛伏病毒是否是標(biāo)準(zhǔn)做法。“我們?nèi)匀粵](méi)有這樣做，”她回憶他說(shuō)。Thus, “l(fā)ong COVID” in some may not be an entirely new entity, but another postviral illness—like ones seen in some patients after Ebola, the original SARS of 2003–2004, and other infections—that overlaps with chronic fatigue syndrome.As top U.S. infectious disease expert Dr. Anthony Fauci said in 2020, long COVID “very well might be a postviral syndrome associated with COVID-19.” 'We’re still not doing that’
It’s possible that COVID is reactivating latent viruses in at least a portion of long COVID patients, causing chronic fatigue syndrome symptoms, Dr. Alba Miranda Azola, codirector of the long COVID clinic at Johns Hopkins University School of Medicine, told Fortune.But her clinic doesn’t check for the reactivation of viruses in long COVID patients. She doesn’t think the possibility of such viruses causing symptoms in patients is worth giving those patients antivirals or antibiotics, which can lead to undesirable side effects. “We don’t have enough evidence to support that treatment,” she said. Other physicians who have prescribed such treatments for long COVID patients, and those patients didn’t see much improvement, Azola added. She recently asked an infectious disease colleague if it was standard practice to test for, and treat, latent viruses in long COVID patients.“We’re still not doing that,” she recalled him saying.丹佛國(guó)家猶太人健康中心的肺病學(xué)家尼爾·戈德斯坦（Nir Goldstein）博士負(fù)責(zé)該醫(yī)院的長(zhǎng)新冠診所，他說(shuō)，目前尚不清楚潛伏病毒在長(zhǎng)新冠中扮演什么角色。那是因?yàn)樾律膊∈且环N復(fù)雜多樣的紊亂狀態(tài)。長(zhǎng)新冠的定義尚未得到普遍的共識(shí)。他指出，已經(jīng)確定存在數(shù)百種可能的癥狀 - 沒(méi)有一種解釋可以解釋所有這些癥狀。“可能存在關(guān)聯(lián)，但很難知道因果關(guān)系，”戈德斯坦說(shuō)。“情況可能正好相反——可能長(zhǎng)新冠導(dǎo)致重新激活，而不是重新激活導(dǎo)致長(zhǎng)新冠?！?/span>帕納吉斯·加利亞薩托斯（Panagis Galiasatos）博士是約翰霍普金斯大學(xué)肺和重癥監(jiān)護(hù)部門的助理教授，他治療長(zhǎng)新冠患者，他不會(huì)定期對(duì)患者進(jìn)行潛伏病毒檢測(cè)，因?yàn)榇蠖鄶?shù)人對(duì)他的診所使用的治療方法反應(yīng)良好。“如果患者對(duì)治療沒(méi)有反應(yīng)，也許我們會(huì)測(cè)試其他東西，”他說(shuō)。加利亞薩托斯補(bǔ)充說(shuō)，新冠很有可能正在削弱 “很多人” 的免疫系統(tǒng)。“我確實(shí)認(rèn)為存在免疫缺陷 - 當(dāng)它在那里時(shí)，它雖然短暫的 - 它可以使這些病毒重新出現(xiàn)，”他說(shuō)。Dr. Nir Goldstein, a pulmonologist at National Jewish Health in Denver, who runs the hospital’s long COVID clinic, said it’s not yet clear what role latent viruses play in the long COVID. That’s because the nascent condition is such a complex and varied disorder.A consensus definition for long COVID hasn’t been universally agreed upon. Hundreds of possible symptoms have been identified, he points out—and no single explanation can account for them all.“There may be an association, but it’s very hard to know the causation,” Goldstein said. “It could be the other way around—it could be that long COVID causes reactivation, not that reactivation causes long COVID.”Dr. Panagis Galiasatos, an assistant professor at Johns Hopkins’ pulmonary and critical care division who treats long COVID patients, doesn’t routinely test his patients for latent viruses, given that most respond well to treatments that his clinic uses.“If a patient doesn’t respond to treatment, maybe we’ll test for other things,” he said.There is a strong possibility that COVID is weakening the immune systems of “a good deal of people,” Galiasatos added.“I do think the immunodeficiency—when it’s there, it’s transient—allows those viruses to reemerge,” he said.十月份的研究指出，科學(xué)家們?nèi)匀徊淮_定像愛潑斯坦 - 巴爾這樣的病毒是否只是引發(fā)慢性疲勞綜合癥或使得癥狀延續(xù)。同樣，研究人員仍然不確定潛伏病毒（包括潛在的新型冠狀病毒本身）在長(zhǎng)新冠的演變中扮演什么角色（如果有的話）。專家說(shuō)，由于對(duì)長(zhǎng)新冠和慢性疲勞綜合癥知之甚少，患者患有哪種疾病并不重要，至少現(xiàn)在不重要。雖然這兩種癥狀都可以治療，但沒(méi)有特定的藥物，因?yàn)樵?- 或原因 - 仍然懸而未決。“這是我甚至不訂購(gòu)測(cè)試的主要原因，”Azola談到長(zhǎng)新冠患者中可能的潛伏病毒的抗體測(cè)試時(shí)說(shuō)。“沒(méi)有針對(duì)慢性疲勞綜合癥的治療方法。當(dāng)然有一些治療方法可以幫助癥狀管理和改善生活質(zhì)量，但它們不能治愈。Goldstein說(shuō)，如果研究人員能夠證明這兩種情況是由殘留病毒引起的，并開發(fā)出一種根除它們的方法，那么描述這兩種情況在未來(lái)可能很重要。Azola有幾名患者在新冠之前，在愛潑斯坦-巴爾病毒或H1N1流感感染后被診斷出患有慢性疲勞綜合癥。她說(shuō)，他們感染了新冠病毒，現(xiàn)在他們的慢性疲勞癥狀要嚴(yán)重得多。“他們記得以前對(duì)他們有用的事情，學(xué)習(xí)如何調(diào)整自己的節(jié)奏，遠(yuǎn)離我所說(shuō)的過(guò)山車般的新冠狀態(tài) - 當(dāng)他們感覺良好時(shí)，做很多事情，然后崩潰幾天，”她說(shuō)?！八麄兡軌蛘J(rèn)同這一點(diǎn)，并實(shí)施過(guò)去對(duì)他們有用的策略。來(lái)自約翰霍普金斯大學(xué)的加利亞托斯，希望新的一年能帶來(lái)長(zhǎng)新冠的突破，包括對(duì)病情的更深入理解和量身定制的治療——可能在2023年底之前。Scientists are still unsure if viruses like Epstein-Barr merely initiate chronic fatigue syndrome or keep symptoms going, the October study points out. Similarly, researchers are still unsure what, if any, role latent viruses—including, potentially, SARS-CoV-2 itself—play in the development of long COVID.With so little known about both long COVID and chronic fatigue syndrome, it doesn’t really matter which a patient has, experts say—at least not right now. While the symptoms of both can be treated, there’s no specific drug for either because the cause—or causes—remain up in the air.“It’s the main reason why I don’t even order the test,” Azola said of antibody tests for possible latent viruses in long COVID patients. “There’s no treatment targeting chronic fatigue syndrome. There certainly are treatments that can help with symptom management and improve quality of life, but they’re not curative.”Delineating the two conditions could matter in the future, Goldstein said, if researchers can prove that the conditions are caused by residual viruses and develop a way to eradicate them.Azola has several patients who were diagnosed with chronic fatigue syndrome before COVID, after Epstein-Barr virus or H1N1 flu infections. They caught COVID, and now their chronic fatigue symptoms are much worse, she says.“They remember the things that worked for them before, learning how to pace themselves, staying out of what I call the corona-coaster—when they’re feeling good, doing a lot, then crashing for days,” she said. “They’re able to identify with that and implement strategies that have worked for them in the past.”Galiasatos, from Johns Hopkins, hopes that the new year brings long COVID breakthroughs, including a deeper understanding of the condition and tailored treatments—potentially by the end of 2023.斯坦福大學(xué)正在招募人員參與一項(xiàng)基于與 10 月研究中類似理論的研究——即長(zhǎng)新冠是由急性感染后導(dǎo)致新冠的 SARS-CoV-2 病毒的揮之不去的殘留所引起的。它將嘗試確定抗病毒藥物Paxlovid是否能通過(guò)減少或消除該病毒庫(kù)來(lái)緩解長(zhǎng)期新冠癥狀。【斯坦福大學(xué)與輝瑞合作，進(jìn)行招募患者，研究是否Paxlovid可以治療長(zhǎng)新冠。目前仍在招募中，無(wú)結(jié)果。鏈接：https://clinicaltrials.gov/ct2/show/study/NCT05576662】“我們開始慢慢進(jìn)入試驗(yàn)治療階段，”阿佐拉說(shuō)。Stanford University is recruiting for a study based on a theory similar to the one in the October study—that long COVID is caused by a lingering reservoir of the SARS-CoV-2 virus, which causes COVID, after acute infection. It will attempt to determine if the antiviral drug Paxlovid alleviates long COVID symptoms by reducing or eliminating that viral reservoir.“We’re starting to move into the trial-treatment phase slowly,” Azola said.
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