clinmedКлиническая медицинаClinical Medicine (Russian Journal)0023-21492412-1339ООО «Медицинское информационное агентство»10.30629/0023-2149-2020-98-4-256-265clinmed-42Research ArticleОБЗОРЫ И ЛЕКЦИИREVIEWS AND LECTURESОсложнения у больных COVID-19. Предполагаемые механизмы коррекцииComplications in COVID-19 patients. Suggested mechanisms of correctionhttps://orcid.org/0000-0001-7547-7725ХавинсонВ. Х.KhavinsonV. Kh.

197110, Санкт-Петербург; 199034, Санкт-Петербург.

197110, St. Petersburg; 199034, St. Petersbsurg.

https://orcid.org/0000-0002-2502-9411КузникБ. И.KuznikB. I.

Кузник Борис Ильич — доктор медицинских наук, профессор, профессор кафедры нормальной физиологии.

672000, Чита.

Kuznik Boris Ilyich — MD, PhD, DSc, prof., professor of the Department of Normal Physiology.

 

672000, Chita.

bi_kuznik@mail.ruСанкт-Петербургский институт биорегуляции и геронтологии; Институт физиологии им. И.П. Павлова РАНРоссияSt. Petersburg Institute of Bioreglation and Gerontology; Pavlov Institute of Physiology RASRussian FederationЧитинская государственная медицинская академия; Инновационная клиника «Академия здоровья»РоссияChita State Medical Academy; Innovative Clinic of the Health AcademyRussian Federation202016092020984256265Copyright © Хавинсон В.Х., Кузник Б.И., 20202020Хавинсон В.Х., Кузник Б.И.Khavinson V.K., Kuznik B.I.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/42

В обзоре представлены данные, свидетельствующие о том, что у тяжелобольных COVID-19 происходит разбалансирование врожденного и адаптивного иммунитета. При этом активируется система комплемента, нарушается взаимосвязь между отдельными субпопуляциями Т-лимфоцитов и возрастает содержание провоспалительных цитокинов и хемокинов, приводящих к развитию так называемого «цитокинового шторма». Одновременно у этих больных возникает гиперкоагуляция, сопровождаемая повышением экспрессии тканевого фактора и фактора фон Виллебранда на эндотелии кровеносных сосудов, усилением агрегации тромбоцитов, а также увеличением D-димера и продуктов деградации фибриногена/фибрина. Это сопровождается развитием микроангиопатии, иммунотромбоза, Диссеминированным внутрисосудистым свертыванием крови и полиорганной недостаточностью. Под воздействием вируса и развившихся сдвигов в иммунитете и гемостазе возникают осложнения со стороны органов дыхания (пневмонии, острый респираторный дистресс-синдром), сердечно-сосудистой системы (вплоть до острой сердечной недостаточности и инфаркта миокарда), желудочно-кишечного тракта, печени, почек и центральной нервной системы (вплоть до энцефалита и инсульта). Для коррекции указанных нарушений, наряду с общепринятой терапией, рекомендуется у людей, находящихся в группе риска возникновения тяжелого течения заболевания и осложнений, уже с первых дней поступления в стационар использовать пептидный иммунокорректор тималин, антикоагулянт гепарин и антиагреганты. Поиск статей для обзора осуществлялся в базе данных PubMed на английском и русском языках. В обзор вошли статьи, опубликованные в период с 2000 по 2020 гг.

The review evidences the imbalance in innate and adaptive immunity in severely ill patients with COVID-19. In this case, the complement system is activated, the relationship between individual subpopulations of T-lymphocytes is disrupted, and the content of pro-inf ammatory cytokines and chemokines increases, thus leading to the development of the so-called «cytokine storm». At the same time, there occurs a hypercoagulation, accompanied by an increase in the expression of tissue and von Willebrand factors on the blood vessel endothelium, increased platelet aggregation, and an increase in the D-dimer and f brinogen/f brin degradation products. These processes are concomitant with the development of microangiopathy, immunothrombosis, disseminated intravascular coagulation and multiple organ failure. Under the inf uence of the virus and the developed immunity and hemostasis shifts, complications in the following systems and organs may occur: respiratory system (pneumonia, acute respiratory distress syndrome), cardiovascular system (up to an acute heart failure and myocardial infarction), the gastro-intestinal tract, liver, kidneys and central nervous system (up to encephalitis and stroke). Therefore, peptide immunity modulator Thymalin, anticoagulant Heparin and anti-platelet agents are recommended to supplement conventional therapy in high-risk patients from the f rst day of their hospitalization in order to correct above disorders. The search of papers for this review has been made through PubMed in the English and Russian languages. The review includes papers published in the period of 2000—2020.

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