medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2020-21-230-237medsovet-5988Research ArticleИНФЕКЦИИINFECTIONSОценка системных воспалительных реакций и коагулопатии на фоне гормональной терапии при ковид-ассоциированном поражении легкихAssessment of systemic inflammatory reactions and coagulopathy against the background of hormonal therapy in covid-associated lung damagehttps://orcid.org/0000-0003-1851-0941СалуховВ. В.SalukhovV. V.

д.м.н., начальник 1-й кафедры и клиники (терапии усовершенствования врачей) имени академика Н.С. Молчанова,

194044, Санкт-Петербург, ул. Академика Лебедева, д. 6

Dr. of Sci. (Med.), Head of the First Department and Clinic (Therapy for Advanced Training of Doctors) named after Academician N.S. Molchanova, 

6, Akademik Lebedev St., St Petersburg, 194044

vlasaluk@yandex.ruhttps://orcid.org/0000-0002-7578-8715ГуляевН. И.GulyaevN. I.

д.м.н., доцент, начальник кардиологического центра,

143420, г/о Красногорск, п. Новый, д. 1

Dr. of Sci. (Med.), Associate Professor, Head of the Cardiology Center, 

1, pos. New, Krasnogorsk urban district, 143420

nig27@mail.ruДорохинаЕ. В.DorokhinaE. V.

слушатель ординатуры 1-й кафедры и клиники (терапии усовершенствования врачей) имени академика Н.С. Молчанова,

194044, Санкт-Петербург, ул. Академика Лебедева, д. 6

Residency Student of the First Department and Clinic (Therapy for Advanced Training of Doctors) named after Academician N.S. Molchanova, 

6, Akademik Lebedev St., St Petersburg, 194044

lena.dorokhina@inbox.ruВоенно-медицинская академия им. С.М. КироваРоссияKirov Military Medical AcademyRussian Federation3-й Центральный военный клинический госпиталь им. А.А. ВишневскогоРоссия3 Central Military Clinical Hospital named after A.A. VishnevskyRussian FederationВоенно-медицинская академия им. С.М. Кирова; 194044, Россия, Санкт-Петербург, ул. Академика Лебедева, д. 6РоссияKirov Military Medical AcademyRussian Federation202016012021021230237Copyright © Салухов В.В., Гуляев Н.И., Дорохина Е.В., 20212021Салухов В.В., Гуляев Н.И., Дорохина Е.В.Salukhov V.V., Gulyaev N.I., Dorokhina E.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/5988

Механизмы COVID-19-ассоциированной коагулопатии (CAC) сложны и во многом отличаются от стандартных механизмов тромбоза у тяжелобольных пациентов. В этом обзоре представлен патогенез, диагностика и сравнение различных типов коагулопатий с САС. В ходе COVID-19-инфекции количество случаев внезапной смерти вне больницы увеличилось. Одна из возможных причин – высокая частота серьезных тромботических событий у пациентов с COVID-19. Однако патогенез этих опасных для жизни событий многофакторен и требует самостоятельного обсуждения.

Отклонения в лабораторных исследованиях системы гемостаза у пациентов, инфицированных SARS-CoV-2 с тяжелым течением, указывают на активацию системы свертывания крови, соответствующей сепсис-индуцированной коагулопатии (СИК) или ДВС. Тем не менее нарушения гемостаза при COVID-19 имеют характеристики, которые отличают их от ДВС при сепсисе.

Клинические и лабораторные особенности CAC частично совпадают с гемофагоцитарным синдромом, антифосфолипидным синдромом и тромботической микроангиопатией. В обзоре представлены данные об их сходстве и различиях.

Недостаточная диагностика или недостаточное лечение гиперкоагуляции могут объяснить высокую частоту необъяснимой смертности от COVID-19. Они могут быть связаны с потенциально предотвратимыми микрососудистыми и макрососудистыми тромбозами и последующими сердечно-сосудистыми осложнениями, включая повреждение миокарда и инфаркт, а также с недостаточной информативностью биомаркеров для их оценки.

Исследования выявления наиболее информативных биомаркеров для принятия решений об усилении антикоагулянтной профилактики у пациентов с тяжелой формой COVID-19 быстро развиваются, и все больше обращают внимание на ТЭГ и ROTEM. В обзоре представлены изменения CAC на фоне проведения гормональной терапии при COVID-19-ассоциированном поражении легких. Пульс-терапия высокими дозами ГКС оказывает быстрый противовоспалительный эффект, однако одновременно повышает уровень D-димера, что увеличивает риск венозного тромбоза и тромбоэмболий. 

The mechanisms of COVID-19-associated coagulopathy (CAC) are complex and differ in many ways from the standard mechanisms of thrombosis in critically ill patients. This review presents the pathogenesis, diagnosis, and comparison of various types of coagulopathy with SAS. During COVID-19 infection, the number of sudden deaths outside the hospital increased. One possible reason is the high incidence of serious thrombotic events in patients with COVID-19. However, the pathogenesis of these life-threatening events is multifactorial and requires independent discussion.

Deviations in laboratory studies of the hemostatic system in patients infected with SARS-CoV-2 with a severe course indicate the activation of the blood coagulation system corresponding to sepsis-induced coagulopathy (SIC) or DIC. However, hemostasis disorders in COVID-19 have characteristics that distinguish them from DIC in sepsis.

The clinical and laboratory features of CAC overlap with hemophagocytic syndrome, antiphospholipid syndrome, and thrombotic microangiopathy. The review presents data on their similarities and differences.

Inadequate diagnosis or inadequate treatment of hypercoagulability may explain the high incidence of unexplained deaths from COVID-19. They can be associated with potentially preventable microvascular and macrovascular thrombosis and subsequent cardiovascular complications, including myocardial injury and infarction, as well as insufficient information content of biomarkers for their assessment.

Research to identify the most informative biomarkers for decision-making to intensify anticoagulant prophylaxis in patients with severe COVID-19 is progressing rapidly, with increasing focus on TEG and ROTEM.

The review presents changes in CAC during hormone therapy for COVID-19-associated lung damage. Pulse therapy with high doses of GCS has a rapid anti-inflammatory effect, but at the same time increases the level of D-dimer, which increases the risk of venous thrombosis and thromboembolism. 

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