Is waqt jo novel SARS-CoV-2 virus (jise COVID19 bhi kaha ja raha hai) se phailne wali bimari hai, har taraf usi ki charcha hai. Ye puri duniya ke insano ke liye ek challenge bani hui hai. Logo ki jaan bachana aur is mahamaari ko rokna is waqt sabse zaruri kaam ban gaye hain.
SARS-CoV-2 virus insano ki cells (koshikao’n) me unhi receptor ke zariye ghusta hai jiske zariye pehle phail chuka SARS-CoV ghusta tha. Ye recpetor hai ACE2 ya angiotensin-converting enzyme 2 receptor. Jab SARS-CoV-2 ka infection phailta hai to virus ACE2 se ja kar judta hai aur usse cell ke andar chala jata hai. Cells ke upar kai sare ACE2 receptor phaile rehte hain, unpar jab virus bind hota hai to wo cell ke andar chale jate hain.
Pehle bhi SARS-CoV ke case me bhi ye dekha ja chuka hai ki SARS-CoV ACE2 ke gene ko dhima/slow (downregulate) kar deta hai jisse ACE2 banna kam ho jata hai.
Jaisa ki ham jante hain ki ACE2 RAS ka ek aham hissa hota hai ( RAS – Renin Angiotensin System, jo ki BP control karne me madad karta hai) aur yadi ye kaam karna band kar de to bahut serious consequence dekhne ko milte hain.
RAS System kya hai – insan ke jism me blood pressure control karne ka kaam kidney karti hai. Iske liye 3 system sath me kaam karte hain. Pehla Liver, dusri kidney aur tesra lungs (phepde).
Liver se Angiotensinogen (ENJI-O-TENSI-NOJAN) naam ka ek protein nikalta hai jisey Kidney se nikalne wala RENIN (jo ki ek protein/enzyme hota hai) todkar ANGIOTENSIN – I me badal deta hai. Is Angiotensi – I ko lungs se nikalne wala ACE enzyme phir todta hai aur ise Angiotensin – II me badal deta hai. Ye Angiotensin – II phir blood pressure ko badhata hai. ACE enzyme jis-sey Angiotensin – II banta hai zyadatar BP control karne ki dawaiya isi ACE par kaam karti hain.
Ye pura system RAS (RENIN – ANGIOTENSIN – SYSTEM) kahlata hai. Ye system bigadne se BP ki mushkile kaafi badh jaati hain.
ACE2, ACE ke sath bahut fine balance me kaam karta hai. ACE2 bhi RAS system ke andar aata hai aur BP aur inflamation ko control karne me aham role ada karta hai.
Bimariyo ke model RAS ka jab balance bigadta hai, jisme ACE high ho jata hai aur ACE2 low ho jata hai to usme atherosclerosis (nasey sakht hone lagti hain), BP badhta hai, heart fail, kidney ki problem aur serious lung damage bhi hota hai.
RAS ki activity lungs me waise hi zyada rehti hai jahan ACE2 bhi zyada matra me rehta hai, ye ACE Angiotensin II ke production ko balance karne ke liye hota hai.
Ye situation aur gambhir ho jati hai jab insan BP kam karne ki dawai le raha ho (jinhe ACE inhibitor hypertensive kahte hain, matlab ACE ke production ko kam karti hain).
Aise me RENIN ki matra badh jati hai aur use balance karne ke liye ACE2 bhi high ho jata hai. (matlab jab high BP ke patients me dawai se ACE ko kam kiya jata hai to RAS ko balance karne ke liye ACE2 ka production badh jata hai). Aise me agar ACE2 ke production me problem aye to dikkat bahut badh jati hai.
Yahan SARS-CoV2 ka role samajh aata hai kyunki ye virus ACE2 ke production ko kam karta hai. Ye ACE2 ka kam ho jana hi sabse main problem hoti hai Corona virus ke infection me jisse neutrophil (ek tarah ki bimariyo se ladne wali cells) lungs me jama hone lagti hain, inflammation hota hai jisse lungs me damage hone lagta hai jisey lung injury kahte hain.
Jaise jaise lungs ka infection badhta hai hyoxia hone lagta hai (kyunki lungs paryapt oxygen supply nahi kar pati to blood me oxygen ki kami ho jati hai jise hypoxia kahte hain)
Hypoxia ki wajah se aur zyada RENIN nikalne lagta hai aur ACE2 imblance aur zyada bigad jata hai. Chinese doctors jo ki corona virus ke outbreak me shuru se kaam kar rahe hain agar unki maaney to hypertension (HIGH BP) sabse bada risk factor hai corona virus (COVID19) ke infection me. Unka kahna hai ki ventilator turant start kar dena chahiye agar blood me oxygen maintain nahi ho paye to.
Mera manna hai ki pehle se ventilation dene ka matlab hai ki us circle ko todna jisme RENIN badhta chala jata hai, RAS acivate rehta hai lekin kai baar ye kafi late ho jata hai.
Wo mariz jo kisi lambi bimari se grasit hote hain unme ACE2 ka level low rehta hai. Aur ye age ke sath sath waise bhi down hota hai, jisse ye baat samajh aati hai ki kyu COVID19 corona virus aged logo ke liye zyada khatarnak hai.
Iske alawa aged purusho me ACE2 ki kafi kami rehti hai. Iska explanation ye hai ki ACE2 X chromosome par hota hai aur kyunki males me ek hi X chromosome hota hai isliye unme ACE2 ka production kam hota hai, to COVID19 ke infection ke dauran bhi ACE2 itna nahi ban pata. Aur kyunki ACE2 receptors kidney, heart, small intestine aur testes me bhi milte hain to COVID19 ke infection se ye hisse bhi prabhavit ho sakte hain.
Agar ham SARS-CoV2 Corona virus dwara RAS ke balance ki bigadne se pehle hi rok le to kai logo ki jane bachayi ja sakti hain. Sabse pehle to high BP ke log jo COVID19 positive hain unko ACE inhibitor dena band kare, ye pehla step ho sakta hai lekin usse bhi acha ye hai ki RAS ko COVID19 se kisi tarah alag kar diya jaye.
Badhti research aur sabut ye batate hain ki VitaminD RAS ka negative endocrine regulator hai matlab agar vitaminD ka level normal hai to wo RAS ki activity ko kam karta hai aur RENIN banne se rokta hai. Dusri baat ye ki vitaminD ACE2 ke production ko badhata hai.
Sardiyo ke samay waise bhi northern hemisphere (uttari desho) me vitaminD ki kami ho jati hai, jahan ye mahamari dekhne ko mil rahi hai aur aise me RAS ka role corona ke infection me nazar andaz nahi kiya ja sakta. Itna hi nahi duniya me jahan bhi corona ka prakop adhik hai wahan vitaminD ki kami mukhya taur par logo me payi jati hai. Aur ye baat kahne ki zarurat nahi jin logo me vitaminD ki kami hoti hai unka immune system waise bhi weak hota hai.
Unbalaced RAS ko vitaminD se balance karne ki vidhi bahut hi sasti aur kargar sabit ho sakti hai corona virus ke infection me. Wo doctor jo is samay corona ke infection se lad rahe hain wo asani se is baat ko bata sakte hain ki low vitaminD corona ko aur ghatak bana raha hai. Agar ham kisi tarah ventilator ki zarurat ko kam kar de jo is bimari ki ek problem hai to ham kafi had tak iske marizo ko bachane me successful ho sakte hain aur marne walo ki sankhya ko kam kar sakte hain.
Ye research jo 2016 me hui isme bhi yahi dekha gaya jin chuho ko LPS (infection) diya gaya unme vitaminD ke receptor (VDR) aur ACE2 ki bhari kami ho gayi. Jabki jin chuho me LPS ka infection diya gaya aur sath me vitaminD bhi diya gaya unme VDR aur ACE2 ki matra kafi badh gayi. Isse bhi yahi baat sabit hoti hai SARS-CoV2 me jo lung injury hoti hai usme vitaminD aham role ada karke bimari ki tezi ko kafi hadd tak kam karta hai.
this article is taken from BMJ https://www.bmj.com/content/368/bmj.m810/rr-24
High blood pressure: Those with the condition told to be extra vigilant during coronavirus https://www.express.co.uk/life-style/health/1257124/high-blood-pressure-hypertension-symptoms-coronavirus-risk-increases
