clinmedКлиническая медицинаClinical Medicine (Russian Journal)0023-21492412-1339ООО «Медицинское информационное агентство»10.30629/0023-2149-2022-100-1-18-31clinmed-339Research ArticleОБЗОРЫ И ЛЕКЦИИREVIEWS AND LECTURESПсихоневрологические и поведенческие расстройства у пациентов с COVID-19Neuropsychiatric and behavioral disorders in patients with COVID-19https://orcid.org/0000-0002-1159-0101РассохинВ. В.RassokhinV. V.

Рассохин Вадим Владимирович — д-р мед. наук, доцент, профессор кафедры социально-значимых инфекций и фтизиопульмонологии ПСПбГМУ им. И. П. Павлова, заведующий лабораторией хронических вирусных инфекций отдела экологической физиологии Института экспериментальной медицины, ведущий научный сотрудник Северо-Западного окружного центра по профилактике и борьбе со СПИДом Санкт-Петербургского научно-исследовательского института эпидемиологии и микробиологии имени Пастера

197022, Санкт-Петербург

197376, Санкт-Петербург

197101, Санкт-Петербург

Rassokhin Vadim V.

197022, Saint Petersburg

197376, Saint Petersburg

197101, Saint Petersburg

ras-doc@mail.ruhttps://orcid.org/0000-0002-2006-2255БеляковН. А.BelyakovN. A.

Беляков Николай Алексеевич — д-р мед. наук, профессор, академик РАН, заведующий кафедрой социально-значимых инфекций и фтизиопульмонологии ПСПб ГМУ им. И. П. Павлова, ведущий научный сотрудник лаборатории хронических вирусных инфекций отдела экологической физиологии Института экспериментальной медицины, руководитель Северо-Западного окружного центра по профилактике и борьбе со СПИДом Санкт-Петербургского научно-исследовательского института эпидемиологии и микробиологии имени Пастера

197022, Санкт-Петербург

197376, Санкт-Петербург

197101, Санкт-Петербург

Belyakov Nikolay A.

197022, Saint Petersburg

197376, Saint Petersburg

197101, Saint Petersburg

ЯковлевА. А.YakovlevA. A.

Яковлев Алексей Александрович — канд. мед. наук, заведующий неврологическим отделением №2 клиники научно-исследовательского института неврологии научно-клинического исследовательского центра ПСПбГМУ им. И. П. Павлова

197022, Санкт-Петербург

Yakovlev Alexey A.

197022, Saint Petersburg

https://orcid.org/0000-0001-6384-2772СимакинаО. Е.SimakinaO. E.

Симакина Ольга Евгеньевна — канд. биол. наук, научный сотрудник лаборатории хронических вирусных инфекций отдела экологической физиологии Института экспериментальной медицины

197022, Санкт-Петербург

197376, Санкт-Петербург

Simakina Olga E.

197022, Saint Petersburg

197376, Saint Petersburg

ФГБОУ ВО «Первый Санкт-Петербургский государственный медицинский университет им. академика И. П. Павлова» Минздрава России; ФГБНУ «Институт экспериментальной медицины»; ФГБН «Санкт-Петербургский научно-исследовательский институт эпидемиологии и микробиологии им. Пастера»РоссияAcademician I. P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of Russian Federation; Institute of Experimental Medicine; St. Petersburg Scientific Research Institute of Epidemiology and Microbiology named after PasteurRussian FederationФГБОУ ВО «Первый Санкт-Петербургский государственный медицинский университет им. академика И. П. Павлова» Минздрава РоссииРоссияAcademician I. P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of Russian FederationRussian FederationФГБОУ ВО «Первый Санкт-Петербургский государственный медицинский университет им. академика И. П. Павлова» Минздрава России; ФГБНУ «Институт экспериментальной медицины»РоссияAcademician I. P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of Russian Federation; Institute of Experimental MedicineRussian Federation20222204202210011831Copyright © Рассохин В.В., Беляков Н.А., Яковлев А.А., Симакина О.Е., 20222022Рассохин В.В., Беляков Н.А., Яковлев А.А., Симакина О.Е.Rassokhin V.V., Belyakov N.A., Yakovlev A.A., Simakina O.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.clinmedjournal.com/jour/article/view/339

В статье обсуждаются эпидемиологические, этиопатогенетические, клинические и диагностические аспекты поражения центральной нервной системы при COVID-19. Вирус SARS-CoV-2 может проходить через физиологические барьеры и достигать кровотока или лимфы, распространяясь в центральной нервной системе человека, инфицировать клетки хозяина по многим метаболическим путям, что определяет особенности клинической картины психоневрологических и поведенческих расстройств у пациента, представленные спектром фенотипов (синдромов), так или иначе ассоциированных с основным инфекционным процессом. Описаны прямое вирус-индуцированное поражение, иммунная дисфункция, избыточное воспаление и тромбофилия/гиперкоагуляция, цитокиновый и метаболический дисбаланс, аутоиммунные изменения, которые являются патогенетическими механизмами развития психоневрологических заболеваний у пациентов с COVID-19. В обзоре обоснована необходимость комплексного обследования, междисциплинарного подхода и многокомпонентной терапии пациентов с новой коронавирусной инфекцией. Динамическое наблюдение за реконвалесцентами COVID-19 позволит объективно говорить о риске развития отдаленных последствий инфицирования SARS-CoV-2, а сохранение клинической настороженности в отношении возможного развития неврологических симптомов у большинства пациентов с новой коронавирусной инфекцией COVID-19 поможет оказать эффективную помощь как в острый период заболевания, так и в период выздоровления, восстановления и комплексной реабилитации: неврологической, психологической, скелетно-мышечной.

The article discusses the epidemiological, etiopathogenetic, clinical, and diagnostic aspects of central nervous system damage in COVID-19. The SARS-CoV-2 virus can pass through physiological barriers and reach the bloodstream or lymph, spreading in the central nervous system of an infected person, infect host cells through many metabolic pathways, which determines the features of the clinical picture of neuropsychiatric and behavioral disorders in the patient, represented by a spectrum of phenotypes (syndromes), one way or another associated with the main infectious process. As a rule, this is a clinical diagnosis based on the results of a comprehensive examination of a patient with COVID-19. Direct virus-induced damage, immune dysfunction, excessive inflammation, thrombophilia/hypercoagulation, cytokine and metabolic imbalance, and autoimmune changes that are pathogenetic mechanisms in developing neuropsychiatric diseases in patients with COVID-19 are described. The review substantiates the need for a comprehensive examination, an interdisciplinary approach, and multicomponent therapy of patients with a new coronavirus infection. Dynamic monitoring of COVID-19 convalescents will allow us to objectively talk about the risk of developing long-term consequences of SARS-CoV-2 infection, and maintaining clinical alertness regarding the possible development of neurological symptoms in most patients with the new COVID-19 coronavirus infection will help to provide effective assistance both in the acute period of the disease and during recovery, recovery and comprehensive rehabilitation: neurological, psychological, musculoskeletal.

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The authors declare that there are no conflicts of interest present.