生物与医学2020ncbi.nlm.nih.gov
SARS-CoV-2 的神经侵袭潜力
The neuroinvasive potential of SARS-CoV2
入门 · 约 30 分钟读完前置知识：病毒学基础、ACE2 受体基本概念
导读
这篇论文探讨 SARS-CoV-2 可能通过鼻腔侵入中枢神经系统（神经侵入）的假说，作者推测神经侵入或许能部分解释为何部分新冠患者会出现呼吸衰竭，并认为戴口罩等防护措施对阻止病毒进入 CNS 至关重要。论文属于早期推测性观点，证据尚不充分。
HN 关注点：病毒是否侵入神经系统的可能性，讨论焦点是这一假说的证据是否可靠，以及它对口罩防护和病情严重性差异的解释意义。
HN 评论精选
这几条评论里：支持 1 质疑 2 补充 1
支持认为神经侵入假说凸显了戴口罩的重要性，轻视新冠危险性是危险的
论文指出：如果 SARS-CoV-2 的神经侵入确实参与了呼吸衰竭的发生，那么戴口罩将是防止病毒进入中枢神经系统最有效的措施；经粪口或结膜途径感染的患者症状可能比经鼻腔感染者轻；神经侵入也可能解释为何有的患者出现呼吸衰竭而有的没有。武汉最早暴露于该病毒的人群大多没有任何防护措施，因此重症患者远多于中国其他城市。这是一个很好的例子，说明把新冠轻视为“不过比流感危险一点”本身就是危险的。美国大多数人的处境与武汉相似：感染范围不明，防护措施缺位，而且我们一直被劝阻“别买口罩”，被告知口罩无效。
aazaa查看英文原文
From the paper: > If the neuroinvasion of SARS-CoV-2 does take a part in the development of respiratory failure in COVID-19 patients, the precaution with masks will absolutely be the most effective measure to protect against the possible entry of the virus into the CNS. It may also be expected that the symptoms of the patients infected via facal-oral or conjunctival route will be lighter than those infected intranasally. The possible neuroinvasion of SARS-CoV-2 may also partially explain why some patients developed respiratory failure, while others not. It is very possible that most of the persons in Wuhan, who were the first exposed to this previously unknown virus, did not have any protective measure, so that the critical patients is much more in Wuhan than in other cities in China. This is a good example of why writing off COVID-19 as no more dangerous than the flu is itself so dangerous. I should also point out that most people in the US face similar conditions to those in Wuhan. The extent of infection is not known, and therefore protective measures are not in place. We have been actively discouraged from "buying masks" and told that they are ineffective.
补充担心康复者可能留下慢性呼吸或神经后遗症
顺带一提：大多数报道相当二元化——要么死要么活。但我更关心的是存活者中有多少能完全康复，尤其是现在神经系统也牵涉进来了。会有长期后遗症吗？康复者应该预期变得更差、一样还是更好？比起死亡，我更害怕的是留下慢性呼吸系统或神经系统问题。
thijsvandien查看英文原文
As a side observation: most reporting seems rather binary, i.e. you either die or survive, period. What interests me the most, however, is how often survival means full recovery, especially now that the nervous system comes up. Are there any long term effects? Should one generally expect to come out of it worse, the same, or stronger? I'm much less afraid to die from this than to end up with chronic respiratory and/or neurological issues.
质疑质疑证据不足，指出可能需要共受体，需更多研究
你是否相信这篇论文，取决于你是否相信其参考文献 32-34。关于小鼠转染人 ACE2 的研究我没细读，但那听起来更像异常表达，所以我不把它算在内。我认为“还需要更多证据”才是正确的解读。另有文献称 ACE2 在全身（包括大脑）广泛表达——这意味着两种可能：要么说它无处不在的人错了，要么 SARS-CoV-2 感染需要 ACE2 以外的因素。有论文表明仅转染 ACE2 并不总能使细胞系易感，所以考虑共受体的存在可能是明智的。真相可能介于这些可能性之间。
hirenj查看英文原文
Whether you believe this or not comes down to whether you believe references 32-34 from the paper. I haven't read the stuff about transgenic expression of human ace2 in mice, but it would sound a lot more like it was aberrantly expressed, so I'm not counting that. "More evidence needed" is the correct interpretation here, I believe. There's other literature out there saying ACE2 is ubiquitously expressed (including brain) - so that means one of two things: People saying it's expressed everywhere are wrong, or SARS-COV-2 requires more than ACE2 for infection. There are papers saying that transfecting cell lines with ACE2 doesn't always render the cells susceptible, so it's probably a good idea to consider the requirement for a co-receptor. Like anything, the true answer probably lies in between all these possibilities.
质疑质疑该论文缺乏其他科学家的关注和佐证
这篇论文已发表近一周，但我在其他地方没见过相关报道。过去几天我读过、听过许多相关领域科学家的访谈，没有人提到这个方向。有人有二手来源链接，能看到其他科学家如何解读这篇论文吗？
hannob查看英文原文
This is almost a week old, I haven't read about it anywhere else. I have read and heard plenty of interviews with scientists involved in this in the past few days and noone has mentioned anything in that direction. Anyone has any link to secondary sources where other scientists try to put this in perspective?
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- 2020Hacker News 讨论帖403 分 · 283 评
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