SARS-CoV-2变异株的遗传学特征和致病特点

doi:10.11958/20220509

摘要/Abstract

摘要：

新型冠状病毒（SARS-CoV-2）可通过基因突变迅速进化,目前SARS-CoV-2变异株被分类为值得关切的变异株（B.1.1.7、B.1.351、P.1、B.1.617.2和B.1.1.529）、待留意的变异株（B.1.427/B.1.429、P.2、B.1.525、P.3、B.1.526、B.1.617.1、C.37和B.1.621）和受监控的变异株。这些变异株对病毒传播性和人群的发病率、再感染及死亡率产生了重大影响。与其他变异株相比,新变异株奥密克戎（Omicron）具有强传染性、免疫逃逸等特征,造成感染激增的高风险。该文概述了SARS-CoV-2变异株的遗传学特征,当前SARS-CoV-2新变异株Omicron流行病学特征、基因突变及临床特征,SARS-CoV-2样本采集方法及检测手段,疫苗接种以及COVID-19治疗等,以利于SARS-CoV-2的防治提供指导。

关键词: SARS病毒, 遗传变异, 突变, 毒力, 新型冠状病毒, 奥密克戎

Abstract:

Coronavirus disease 2019 (COVID-19) can evolve rapidly via genetic mutation. At present, SARS-CoV-2 variants have been categorized as of concern variants (B.1.1.7, B.1.351, P.1, B.1.617.2 and B.1.1.529), variants of interest (B.1.427/B.1.429, P.2, B.1.525, P.3, B.1.526, B.1.617.1, C.37 and B.1.621) and variants under monitoring. These variants have had a significant impact on with significant impact on transmissibility of virus, morbidity, reinfection and mortality in the population. Compared to other variants, Omicron new variant has characteristics such as strong infectivity, immune escape, causing a high risk of infection surges. This review outlines genetic characteristics of SARS-CoV-2 variants, the epidemiological, gene mutation and clinical characteristics of new variant Omicron of SARS-CoV-2, the collection method and detective method of SARS-CoV-2 specimen, vaccination and treatment for COVID-19, in order to provide guidance for the prevention and treatment of SARS-CoV-2.

Key words: SARS virus, genetic variation, mutation, virulence, SARS-CoV-2, Omicron

中图分类号:

R373.1

图/表 4

参考文献 31

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VOC	首次报告	S蛋白基因突变位点
		S1			S2
		受体结合区域（RBD）	N-端区域（NTD）	其他	S2
B.1.1.7（Alpha）	2020.09英国	N501Y	Δ69~70、Δ144~145	A570D、D614G、P681H	T716l、S982A、D1118H
B.1.351（Beta）	2020.05南非	K417N、E484K、N501Y	D80A、D215G、Δ242~244	D614G	A701V
P.1（Gamma）	2020.11巴西	K417T、E484K、N501Y	L18F、T20N、P26S、 D138Y、R190S	D614G、H655Y	T1027l、V1176F
B.1.617.2（Delta）	2020.10印度	L452R、T478K	T19R、E156G、Δ157~158	D614G、P681R	D950N
B.1.1.529 （Omicron）	2021.11 博茨瓦纳	G339D、S371L、S373P、S375F、K417N、 N440K、G446S、S477N、T478K、E484A、 Q493R、G496S、Q498R、N501Y、Y505H	A67V、Δ69~70、T95I、 G142D、Δ143-145、 Δ211、L212I、ins214EPE	T547K、D614G、H655Y、 N679K、P681H	N764K、D796Y、 N856K、Q954H、 N969K、L981F
VOC	影响
VOC	传播力		致病性	免疫逃逸能力
B.1.1.7 （Alpha）	比原始毒株高43%~82%		致死率比原始毒株高64%	恢复期患者的血清中和活性约降低至原来的1/4;疫苗接种者的血清中和活性约降低至原来的1/3
B.1.351 （Beta）	比原始毒株高约50%		院内致死风险比已报道毒株高31%	恢复期患者的血浆中和活性降低至原来的1/34~1/12;疫苗接种者的血清中和活性降低至原来的1/9.5~1/4.4
P.1 （Gamma）	是原始毒株的1.7~2.4倍		对20~49岁女性的致死率升高	恢复期患者的血浆中和活性降低至原来的1/14~1/7.5;疫苗接种者的血清中和活性降低至原来的1/3.8~1/3.2
B.1.617.2 （Delta）	比原始毒株高97%,比Alpha 变异株高40%~50%		危重症率高于原始毒株;致死率比原始毒株高133%	恢复期患者及疫苗接种者的血清中和活性均有所降低
B.1.1.529 （Omicron）	为Delta变异株的3~6倍		相对较低	恢复期患者血清的中和敏感性降低,但仍有一定的保护作用;既往感染过其他变异株且未接种疫苗患者的血清不能中和Omicron变种

VOC	首次报告	S蛋白基因突变位点
		S1			S2
		受体结合区域（RBD）	N-端区域（NTD）	其他	S2
B.1.1.7（Alpha）	2020.09英国	N501Y	Δ69~70、Δ144~145	A570D、D614G、P681H	T716l、S982A、D1118H
B.1.351（Beta）	2020.05南非	K417N、E484K、N501Y	D80A、D215G、Δ242~244	D614G	A701V
P.1（Gamma）	2020.11巴西	K417T、E484K、N501Y	L18F、T20N、P26S、 D138Y、R190S	D614G、H655Y	T1027l、V1176F
B.1.617.2（Delta）	2020.10印度	L452R、T478K	T19R、E156G、Δ157~158	D614G、P681R	D950N
B.1.1.529 （Omicron）	2021.11 博茨瓦纳	G339D、S371L、S373P、S375F、K417N、 N440K、G446S、S477N、T478K、E484A、 Q493R、G496S、Q498R、N501Y、Y505H	A67V、Δ69~70、T95I、 G142D、Δ143-145、 Δ211、L212I、ins214EPE	T547K、D614G、H655Y、 N679K、P681H	N764K、D796Y、 N856K、Q954H、 N969K、L981F
VOC	影响
VOC	传播力		致病性	免疫逃逸能力
B.1.1.7 （Alpha）	比原始毒株高43%~82%		致死率比原始毒株高64%	恢复期患者的血清中和活性约降低至原来的1/4;疫苗接种者的血清中和活性约降低至原来的1/3
B.1.351 （Beta）	比原始毒株高约50%		院内致死风险比已报道毒株高31%	恢复期患者的血浆中和活性降低至原来的1/34~1/12;疫苗接种者的血清中和活性降低至原来的1/9.5~1/4.4
P.1 （Gamma）	是原始毒株的1.7~2.4倍		对20~49岁女性的致死率升高	恢复期患者的血浆中和活性降低至原来的1/14~1/7.5;疫苗接种者的血清中和活性降低至原来的1/3.8~1/3.2
B.1.617.2 （Delta）	比原始毒株高97%,比Alpha 变异株高40%~50%		危重症率高于原始毒株;致死率比原始毒株高133%	恢复期患者及疫苗接种者的血清中和活性均有所降低
B.1.1.529 （Omicron）	为Delta变异株的3~6倍		相对较低	恢复期患者血清的中和敏感性降低,但仍有一定的保护作用;既往感染过其他变异株且未接种疫苗患者的血清不能中和Omicron变种