lvrachЛечащий ВрачLechaschi Vrach1560-51752687-118110.51793/OS.2021.24.6.010lvrach-769Research ArticleАКТУАЛЬНАЯ ТЕМАTOPICAL THEMEСостояние цитокиновой системы у больных с тяжелой формой COVID-19The state of the cytokine system in patients with severe COVID-19ГришаеваА. А.GrishaevaA. A.

Москва

Moscow

ПонежеваЖ. Б.PonezhevaZh. B.

доктор медицинских наук

Москва

Moscow

doktorim@mail.ruЧанышевМ. Д.ChanyshevM. D.

кандидат биологических наук 

Москва

Moscow

ПлоскиреваА. А.PloskirevaA. A.

доктор медицинских наук, профессор 

Москва

Moscow

МаннановаИ. А.MannanovaI. A.

кандидат медицинских наук 

Москва

Moscow

АлешинаН. И.AleshinaN. I.

кандидат медицинских наук 

Москва

Moscow

ЧенцовВ. Б.ChentsovV. B.

кандидат медицинских наук 

Москва

Moscow

КрасноваС. В.KrasnovaS. V.

кандидат медицинских наук 

Москва

Moscow

ФБУН ЦНИИЭ РоспотребнадзораРоссияThe Central Research Institute of Epidemiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human WellBeingRussian FederationФГАОУ ВО РНИМУ им. Н. И. Пирогова Минздрава РоссииРоссияN. I. Pirogov Russian National Research Medical UniversityRussian FederationГБУЗ ИКБ № 2 ДЗМРоссияInfectious Diseases Clinical Hospital № 2Russian Federation202121072021064851Copyright © Гришаева А.А., Понежева Ж.Б., Чанышев М.Д., Плоскирева А.А., Маннанова И.А., Алешина Н.И., Ченцов В.Б., Краснова С.В., 20212021Гришаева А.А., Понежева Ж.Б., Чанышев М.Д., Плоскирева А.А., Маннанова И.А., Алешина Н.И., Ченцов В.Б., Краснова С.В.Grishaeva A.A., Ponezheva Z.B., Chanyshev M.D., Ploskireva A.A., Mannanova I.A., Aleshina N.I., Chentsov V.B., Krasnova S.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.lvrach.ru/jour/article/view/769

Инфекция COVID-19 является одной из самых актуальных проблем современного здравоохранения. Несмотря на прогресс, достигнутый в понимании патогенеза данной инфекции, в настоящее время отсутствуют прогностические критерии утяжеления и летального исхода. Рядом авторов предложено рассматривать некоторые интерлейкины (ИЛ) в качестве маркеров прогноза тяжелого течения. Нами была проанализирована клинико-лабораторная характеристика больных с тяжелым течением COVID-19, включая исследование уровней ИЛ-1, ИЛ-6, ИЛ-10. Под наблюдением находились 49 пациентовс тяжелой формой COVID-19 в возрасте от 18 до 90 лет, госпитализированных в отделение реанимации и интенсивной терапии инфекционного стационара. У всех пациентов диагноз был подтвержден выявлением РНК SARS-CoV-2 методом ПЦР в мазках из носоглотки и ротоглотки. У 47 пациентов наблюдался отягощенный преморбидный фон. При поступлении самыми частыми жалобами являлись лихорадка, одышка и сухой кашель. У всех больных была диагностирована двусторонняя полисегментарная пневмония, тяжелая форма (КТ-3/4) наблюдалась у 32,7% больных. Анализ исследуемых цитокинов (ИЛ-1, ИЛ-6, ИЛ-10) в сыворотке крови больных с тяжелым течением COVID-19 выявил, что ИЛ-6 был повышен у 75%, в то время как повышение уровня ИЛ-10 отмечено менее чем у половины больных (46,9%), а показатель ИЛ-1 выше нормы регистрировали менее чем у трети пациентов (12,2%.) Проанализированы клинико-лабораторные особенности у пациентов с COVID-19 тяжелого течения в зависимости от исхода болезни в группах сравнения: группа 1 – выжившие; умершие – группа 2. В группе 1 повышение концентрации ИЛ-6 регистрировали у 73,9% исследуемых, ИЛ-1 – только в 4,3% случаев, а ИЛ-10 – у 21,7% больных. При этом в группе 2 (с летальным исходом) выявлены повышенные концентрации ИЛ-6 у 96,2% больных, ИЛ-10 и ИЛ-1 – в 69,2% и 21,7% случаев соответственно. Одновременное повышение трех исследуемых цитокинов наблюдалось только у 12,2% пациентов – все они относились к группе 2. Таким образом, исследуемые цитокины могут рассматриваться как потенциальные прогностические маркеры летального исхода у больных с тяжелой формой COVID-19.

COVID-19 infection is one of the most actual problems of modern healthcare. Despite the progress made in understanding of the pathogenesis of this infection, there are currently no prognostic criteria for aggravation and death. A number of authors propose to consider interleukins 1, 6, 10 (IL-1, IL-6, IL-10) as markers of the prognosis of a severe course. We analyzed the clinical and laboratory characteristics of patients with severe COVID-19, including the interleukin 1, 6, 10 levels. We observed 49 patients with a severe form of COVID-19 aged 18 to 90 years, hospitalized in the intensive care unit of the Infectious Hospital. The diagnosis of Covid-19 was confirmed by the detection of SARS-CoV-2 RNA by PCR in nasopharyngeal and oropharyngeal smears. 47 patients had a burdened premorbid background. The most frequent complaints on admission were fever, shortness of breath, and dry cough. Bilateral polysegmental pneumonia was diagnosed at admission in all patients, but severe form (CT-3/4) was observed only in 32,7% of patients. Analysis of the studied cytokines (IL-1, IL-6, IL-10) in the blood serum of patients with severe Covid-19 revealed that IL-6 was elevated in more than 75% cases, while an increase in the level of IL-10 was noted in less than half of the patients (46,9%), and the IL-1 index above the baseline was recorded in less than a third of patients (12,2%).) We analyzed the clinical and laboratory characteristics of patients with severe COVID-19, depending on the outcome of the disease by the comparison groups: group 1 – survivors and group 2 – lethal. An increase of the concentration of IL-6 in group 1 was observed in 73,9% of the subjects, IL-1 – only in 4,3% of cases, and IL-10 – in 21,7% of patients. Elevated concentrations of IL-6 were detected in group 2 (with a fatal outcome) in 96,2% of patients, IL-10 in 69,2% of cases and IL-1 in 21,7% of patients. A simultaneous increase in the three cytokines studied was observed only in 12,2% of patients – all of them belonged to group 2. Thus, the cytokines studied can be considered as potential lethal markers for patients with severe COVID-19.

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