medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2023-093medsovet-7432Research ArticleCOVID-19Постковидный синдром: клиническая картина и терапевтические подходыPost-COVID syndrome: clinical presentations and therapeutic approacheshttps://orcid.org/0000-0002-5536-9388ЧикинаС. Ю.ChikinaS. Yu.

Чикина Светлана Юрьевна – кандидат медицинских наук, ассистент кафедры пульмонологии Института клинической медицины имени Н.В. Склифосовского.

119991, Москва, ул. Трубецкая, д. 8, стр. 2

Svetlana Yu. Chikina - Cand. Sci. (Med.), Teaching Assistant of the Department of Pulmonology, N.V. Sklifosovsky Institute of Clinical Medicine Sechenov First Moscow State Medical University (Sechenov University).

8, Bldg. 2, Trubetskaya St., Moscow, 119991

clinic@integramed.ruПервый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)РоссияSechenov First Moscow State Medical University (Sechenov University)Russian Federation202313042023046469Copyright © Чикина С.Ю., 20232023Чикина С.Ю.Chikina S.Y.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/7432

В статье представлен обзор литературы по патогенезу, клиническим и рентгенологическим проявлениям и вариантам терапии постковидного синдрома. Патофизиологической основой повреждения легких при тяжелом COVID-19 и ОРДС любой другой этиологии является острое повреждение альвеолярного эпителия и эндотелия легочных сосудов с повышением альвеолярно-капиллярной проницаемости, интерстициальным и альвеолярным отеком, формированием гиалиновых мембран и скоплением нейтрофилов в легочной ткани. После завершения острой фазы начинается гиперплазия альвеолоцитов II типа, пролиферация фибробластов и миофибробластов как проявления репаративных процессов. Постковидный синдром объединяет патологические состояния, сопровождающиеся клинически значимым снижением качества жизни и риском летального исхода и персистирующие в течение длительного времени после исчезновения инфекционных симптомов заболевания. Постковидные уплотнения легочной паренхимы сопровождаются нарушениями вентиляционной функции легких, нередко развитием хронической дыхательной недостаточности с гипоксемией, индуцируемой физической нагрузкой, снижают качество жизни пациентов и требуют лечения. В настоящее время предпринимаются попытки использования различных лекарственных препаратов для лечения постковидных интерстициальных изменений в легких, однако доказательная база для выработки рекомендаций сегодня недостаточна. Одним из перспективных препаратов является бовгиалуронидаза азоксимер. В настоящее время в РФ проводится многоцентровое рандомизированное двойное слепое плацебоконтролируемое клиническое исследование в параллельных группах, призванное оценить эффективность бовгиалуронидазы азоксимера у пациентов с постковидными интерстициальными изменениями    в легких, результаты которого могут представить достоверную информацию о месте и роли этого препарата в терапии постковидных интерстициальных изменений в легких.

The article presents a literature review on the pathogenesis, clinical and radiological manifestations and therapy options for post-COVID syndrome. The pathophysiological mechanisms underlying lung injury in severe COVID-19 and ARDS of any other aetiology include acute injury to the alveolar epithelium and pulmonary vascular endothelium with increased alveolar-capillary permeability, interstitial and alveolar oedema, formation of hyaline membranes, and accumulation of neutrophils in the lung tissue. The completion of the acute phase is followed by hyperplasia of type II alveolocytes, proliferation of fibroblasts and myofibroblasts as manifestations of the reparative processes. Post-COVID syndrome combines pathological conditions that are accompanied by the clinically meaningful decline in quality of life and risk of death and persist for a long time after the disappearance of the infectious symptoms of the disease. Post-COVID lung parenchymal consolidations are accompanied by impaired pulmonary ventilation, frequent development of chronic respiratory failure with exercise-induced hypoxemia, reduce the patients’ quality of life and require treatment. Currently, attempts are being made to use various drugs for the treatment of post-COVID interstitial changes in lungs, but the evidence base for providing guidelines is currently insufficient. Bovhyaluronidase azoximer is one of the promising drugs. A multicenter, randomized, double-blind, placebo-controlled, parallel-group clinical trial to evaluate the efficacy of bovhyaluronidase azoximer in patients with post-covid interstitial changes in lungs is currently being conducted in the Russian Federation. The study results can provide reliable information about the place and role of this drug in the treatment of post-COVID interstitial changes in lungs.

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