Патогенез поражений нервной системы и клинические синдромы новой коронавирусной инфекции COVID-19

На основании анализа литературных данных освещены вопросы неврологических осложнений после новой коронавирусной инфекции COVID-19. Существует мало доказательств прямого механизма нейроинвазивности и нейротоксичности вируса SARS-CoV-2. Обсуждаются различные механизмы проникновения коронавирусов в головной мозг — антероградный и ретроградный, нейрональное распространение, транскрипционный и гематогенный пути. Ретроградный/антероградный транспорт и транссинаптический перенос вируса подтверждены исследованиями in vitro. Проникновение вируса в центральную нервную систему возможно также путем распространения по периферическим нервам, например, по блуждающему, который иннервирует легкие и кишечник. Есть несколько возможных механизмов распространения SARS-CoV-2 через гематоэнцефалический барьер: циркуляция вирусных частиц в кровотоке, вирусный трансцитоз через эндотелиальные клетки сосудов и капилляров, инфицирование вирусами лейкоцитов и перенос ими вирусов сквозь гематоэнцефалический барьер. Гипоксия, вызванная цитокиновым штормом, и респираторный дистресс приводят к нарушению метаболизма мозга и развитию неврологических осложнений.

Цель работы. Анализ данных литературы по изучению ранних и отдаленных проявлений неврологических нарушений и болезней при новой коронавирусной инфекции, постковидном синдроме (long COVID-19), а также после вакцинации.

Результаты. Среди большого количества нарушений нервной системы выделяют пять основных видов с длительно существующими неврологическими осложнениями, связанных с СOVID-19: 1) энцефалопатии с делирием/психозом; 2) воспалительные синдромы центральной нервной системы; 3) ишемические инсульты; 4) периферические невропатии, в частности, синдром Гиена–Барре и плечевые плексопатии; 5) другие расстройства центральной нервной системы.

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