Критический анализ концепции «цитокиновой бури» у пациентов с новой коронавирусной инфекцией COVID-19. Обзор литературы
№ 1 (2021) , ИНТЕНСИВНАЯ ТЕРАПИЯ НОВОЙ КОРОНАВИРУСНОЙ ИНФЕКЦИИ COVID-19
№ 1 (2021)
ИНТЕНСИВНАЯ ТЕРАПИЯ НОВОЙ КОРОНАВИРУСНОЙ ИНФЕКЦИИ COVID-19

Критический анализ концепции «цитокиновой бури» у пациентов с новой коронавирусной инфекцией COVID-19. Обзор литературы

https://doi.org/10.21320/1818-474X-2021-1-57-68
Опубликован 05.03.2021
С.С. Бобкова
ГБУЗ «Городская клиническая больница №40» ДЗМ, Москва, Россия
https://orcid.org/0000-0001-6931-4305
А.А. Жуков
ГБУЗ «Городская клиническая больница №40» ДЗМ, Москва, Россия
https://orcid.org/0000-0002-3608-5363
Д.Н. Проценко
ГБУЗ «Городская клиническая больница №40» ДЗМ, Москва, Россия; ФГАОУ ВО «Национальный исследовательский медицинский университет им. Н.И. Пирогова» МЗ РФ, Москва, РФ
https://orcid.org/0000-0002-5166-3280
Валерий Вячеславович Самойленко
ГБУЗ «Городская клиническая больница №40» ДЗМ, Москва, Россия
https://orcid.org/0000-0003-4460-7165
И.Н. Тюрин
ГБУЗ «Городская клиническая больница №40» ДЗМ, Москва, Россия; ФГАОУ ВО «Национальный исследовательский медицинский университет им. Н.И. Пирогова» МЗ РФ, Москва, РФ
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Ключевые слова

COVID-19
SARS-CoV-2
цитокины
«цитокиновая буря»
гипервоспалительный синдром
иммуномодулирующая терапия

Как цитировать

Бобкова С.С., Жуков А.А., Проценко Д.Н., Самойленко В.В., Тюрин И.Н. Критический анализ концепции «цитокиновой бури» у пациентов с новой коронавирусной инфекцией COVID-19. Обзор литературы. Вестник интенсивной терапии имени А.И. Салтанова. 2021;(1):57–68. doi:10.21320/1818-474X-2021-1-57-68.
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Аннотация

Актуальность. Новая коронавирусная инфекция, вызванная вирусом SARS-CoV-2, характеризуется системной гипервоспалительной реакцией с выраженным повышением содержания провоспалительных цитокинов, получившей название «цитокиновая буря». По современным представлениям, «цитокиновая буря» является ведущей причиной развития тяжелой клинической картины COVID-19 и прогрессирования заболевания до полиорганной недостаточности.

Цель исследования. Проведение критического анализа концепции «цитокиновой бури» у пациентов с COVID-19 на основании данных литературы.

Результаты. При сравнении цитокинового ответа при COVID-19 и других синдромах, характеризующихся феноменом «цитокиновой бури», в частности гемофагоцитарного лимфогистиоцитоза и синдрома высвобождения цитокинов, выявляются существенные различия, и поэтому патогенез возникновения нарушений цитокинового ответа при COVID-19 нуждается в дальнейшем уточнении. К настоящему времени накоплены клинические данные, свидетельствующие о потенциальной пользе применения противовоспалительной иммуномодулирующей терапии у пациентов с тяжелым течением COVID-19. Несмотря на проведенные многочисленные исследования по оценке эффективности и безопасности таргетной терапии иммуномодулирующими препаратами, однозначных выводов и рекомендаций по их применению нет. Кроме того, результаты ряда работ ставят под сомнение ведущую роль «цитокиновой бури» в патогенезе прогрессирования COVID-19.

Заключение. Имеющиеся данные позволяют предположить, что нарушение регуляции цитокинового ответа является одним из механизмов, лежащих в основе прогрессирования COVID-19 и развития органной недостаточности. В то же время выраженность данных нарушений у части больных не позволяет объяснить развитие тяжелых осложнений, в связи с чем необходим поиск альтернативных патогенетических механизмов.

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