medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2022-049medsovet-7486Research ArticleCOVID-19Применение глюкокортикоидов в комплексной терапии COVID-19Glucocorticoids in the combination therapy of COVID-19https://orcid.org/0000-0002-2164-3537СкворцовВ. В.SkvortsovV. V.

Скворцов Всеволод Владимирович, д.м.н., профессор кафедры внутренних болезней 

400131, Волгоград, площадь Павших борцов, д. 1

Vsevolod V. Skvortsov, Dr. Sci. (Med.), Professor of the Department of Internal Diseases 

1, Pavshikh Bortsov Square, Volgograd, 400131

vskvortsov1@ya.ruhttps://orcid.org/0000-0002-5947-7992ТумаренкоА. В.TumarenkoA. V.

Тумаренко Александр Владимирович, к.м.н., доцент кафедры внутренних болезней 

400131, Волгоград, площадь Павших борцов, д. 1

Aleksander V. Tumarenko, Cand. Sci. (Med.), Associate Professor, Department of Internal Medicine 

1, Pavshikh Bortsov Square, Volgograd, 400131

al.volga2017@yandex.ruhttps://orcid.org/0000-0002-6433-9068МалякинаЭ. А.MalyakinaE. A.

Малякина Эллина Альбертовна, клинический ординатор 

117198, Москва, ул. Миклухо-Маклая, д. 6

Ellina A. Malyakina, Clinical Resident 

6, Miklukho-Maklai St., Moscow, 117198

golieva133@yandex.ruhttps://orcid.org/0000-0002-1128-2678МалякинГ. И.MaljakinG. I.

Малякин Георгий Ильич, клинический ординатор 

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

Georgiy I. Maljakin, Clinical Resident 

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

manuljke@gmail.comВолгоградский государственный медицинский университетРоссияVolgograd State Medical UniversityRussian FederationРоссийский университет дружбы народовРоссияPeoples’ Friendship University of RussiaRussian FederationПервый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)РоссияSechenov First Moscow State Medical University (Sechenov University)Russian Federation202304052023065256Copyright © Скворцов В.В., Тумаренко А.В., Малякина Э.А., Малякин Г.И., 20232023Скворцов В.В., Тумаренко А.В., Малякина Э.А., Малякин Г.И.Skvortsov V.V., Tumarenko A.V., Malyakina E.A., Maljakin G.I.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/7486

С первых месяцев пандемии SARS-CoV-2 понимание того факта, что тяжелые формы COVID-19 связаны с системным воспалением, побудило медицинское сообщество к большим усилиям по оценке эффекта многочисленных противовоспалительных и иммуномодулирующих методов лечения. Кортикостероиды обладают широким и неспецифическим противовоспалительным действием, они могут влиять на транскрипцию мРНК воспалительных цитокинов, снижая выработку медиаторов воспаления. Следовательно, использование глюкокортикоидов уменьшит осложнения, вызванные цитокиновым штормом. С другой стороны, иммуносупрессия в респираторном эпителии может задерживать элиминацию вируса и предрасполагать ко вторичным инфекциям и клиническому ухудшению. Поэтому ВОЗ в настоящее время не рекомендует рутинное использование кортикостероидов при лечении пациентов с COVID-19. Исследование RECOVERY показало снижение смертности при применении дексаметазона у пациентов с гипоксемией COVID-19, а также увеличение числа дней без ИВЛ среди пациентов в критическом состоянии. Комитет REMAP-CAP пришел к выводу, что среди пациентов с тяжелой формой COVID-19 7-дневный курс лечения гидрокортизоном с фиксированной или шокозависимой дозировкой по сравнению с его отсутствием привел к  вероятности достижения шансов на  исчезновение необходимости в  поддержке органов дыхания и  сердца в  течение 21 дня соответственно 93 и 80%. Результаты исследований показывают, что в группе высоких доз нет статистических различий между применением стероидов и смертностью пациентов с COVID-19, в то время как в группе средних доз статистические различия есть. Группа менее 5 дней показала тесную связь между снижением смертности пациентов с COVID-19 и использованием стероидов, в то время как в группах 5–7 и более 7 дней статистически значимых ассоциаций нет. Учитывая эффективность и логичность применения кортикостероидов, стоит обратить внимание на использование их ингаляционных форм.

Since the early months of the SARS-CoV-2 pandemic, the understanding that severe forms of COVID-19 are associated with systemic inflammation has spurred the medical community to greater efforts to evaluate the effect of numerous anti-inflammatory and immunomodulatory therapies. Corticosteroids have a broad and non-specific anti-inflammatory action; they can interfere with mRNA transcription of inflammatory cytokines, reducing the production of inflammatory mediators. Therefore, the use of glucocorticoids will reduce the complications caused by the cytokine storm. On the other hand, immunosuppression in the respiratory epithelium may delay viral clearance and predispose to secondary infections and clinical deterioration. Therefore, WHO does not currently recommend the routine use of corticosteroids in the treatment of patients with COVID-19. The RECOVERY study showed a reduction in mortality with dexamethasone in patients with COVID-19 hypoxemia, as well as an increase in the number of days without mechanical ventilation among critically ill patients. The REMAP-CAP Committee concluded that among patients with severe COVID-19, treatment with a 7-day course of various hydrocortisone dose versus no hydrocortisone resulted in 93 and 80% chances of eliminating the need for respiratory and cardiac support for 21 days. The results of studies conducted show that there was no statistical difference between steroid use and mortality in patients with COVID-19 in the high dose group, while there was statistical difference in the medium dose group. The less 5 days group showed a strong association between reduced mortality in patients with COVID-19 and steroid use, while there were no statistically significant associations in the 5–7 days group and the more than 7 days group. Inhaled forms of corticosteroids deserve attention given their effectiveness and logical use.

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