medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2023-323medsovet-7916Research ArticleCOVID-19Трудности диагностики осложнений COVID-19: описание клинического случаяDifficulties in diagnosing complications of COVID-19: description of a clinical casehttps://orcid.org/0000-0002-3043-8674ЛошковаЕ. В.LoshkovaE. V.

Лошкова Елена Владимировна, кандидат медицинских наук, доцент кафедры госпитальной педиатрии, доцент кафедры факультетской педиатрии с курсом детских болезней лечебного факультета, Сибирский государственный медицинский университет; старший научный сотрудник отдела наследственных и метаболических заболеваний, Научно-исследовательский клинический институт детства

634050, Томск, Московский тракт, д. 2,

115093, Москва, ул. Большая Серпуховская, д. 62

Elena V. Loshkova, Cand. Sci. (Med.), Associate Professor of the Department of Hospital Pediatrics, Associate Professor of the Department of Faculty Pediatrics with a Course in Childhood Diseases, Faculty of Medicine, Siberian State Medical University; Senior Researcher, Department of Hereditary and Metabolic Diseases, Research Clinical Institute of Childhood

2, Moskovsky Trakt, Tomsk, 634050,

62, Bolshaya Serpukhovskaya St., Moscow, 115093

loshkova.ev@ssmu.ruhttps://orcid.org/0000-0003-2302-4446РебриенкоМ. В.RebrienkoM. V.

Ребриенко Маргарита Валерьевна, студент педиатрического факультета

634050, Томск, Московский тракт, д. 2

Margarita V. Rebrienko, Student of the Pediatric Faculty

2, Moskovsky Trakt, Tomsk, 634050

margaritarebrienko@gmail.comhttps://orcid.org/0000-0002-0747-5952ДорошенкоИ. В.DoroshenkoI. V.

Дорошенко Иван Владимирович, студент педиатрического факультета

634050, Томск, Московский тракт, д. 2

Ivan V. Doroshenko, Student of the Pediatric Faculty

2, Moskovsky Trakt, Tomsk, 634050

vanyadoro2016@gmail.comhttps://orcid.org/0000-0003-2048-1852ЛюлькаТ. С.LyulkaT. S.

Люлька Татьяна Сергеевна, студент педиатрического факультета

634050, Томск, Московский тракт, д. 2

Tatyana S. Lyulka, Student of the Pediatric Faculty

2, Moskovsky Trakt, Tomsk, 634050

tan.lul1999@gmail.comhttps://orcid.org/0009-0008-7135-7361БудкинА. В.BudkinA. V.

Будкин Александр Владимирович, врач-педиатр паллиативного отделения

634050, Томск, ул. К. Маркса, д. 52

Aleksander V. Budkin, Pediatrician of the Palliative Department

52, K. Marks St., Tomsk, 634050

pyos13@gmail.comhttps://orcid.org/0000-0002-3281-803XРафиковаЮ. С.RafikovaYu. S.

Рафикова Юлия Сергеевна, кандидат медицинских наук, доцент кафедры госпитальной педиатрии

634050, Томск, Московский тракт, д. 2

Yulia S. Rafikova, Cand. Sci. (Med.), Associate Professor of the Department of Hospital Pediatrics

2, Moskovsky Trakt, Tomsk, 634050

rafikova411@rambler.ruhttps://orcid.org/0000-0001-6395-0407КондратьеваЕ. И.KondratyevaE. I.

Кондратьева Елена Ивановна, доктор медицинских наук, профессор, заместитель директора, Научно-исследовательский клинический институт детства; руководитель научно-клинического отдела муковисцидоза, заведующая кафедрой генетики болезней дыхательной системы, Медико-генетический научный центр имени академика Н.П. Бочкова

115093, Москва, ул. Большая Серпуховская, д. 62,

115522, Москва, ул. Москворечье, д. 1

Elena I. Kondratyeva, Dr. Sci. (Med.), Professor, Deputy Director, Research Clinical Institute of Childhood; Head of the Scientific and Clinical Department of Cystic Fibrosis, Head of the Department of Genetics of Respiratory System Diseases, Medical Genetic Research Center named after Acad. N.P. Bochkov

62, Bolshaya Serpukhovskaya St., Moscow, 115093,

1, Moskvorechye St., Moscow, 115522

elenafpk@mail.ruhttps://orcid.org/0000-0001-7308-7280ХавкинА. И.KhavkinA. I.

Хавкин Анатолий Ильич, доктор медицинских наук, профессор, руководитель Московского областного центра детской гастроэнтерологии и гепатологии, Научно-исследовательский клинический институт детства; главный научный сотрудник отдела гастроэнтерологии Научно-исследовательского клинического института педиатрии имени академика Ю.Е. Вельтищева, профессор кафедры педиатрии с курсом детских хирургических болезней, Российский национальный исследовательский медицинский университет имени Н.И. Пирогова

115093, Москва, ул. Большая Серпуховская, д. 62,

125412, Москва, ул. Талдомская, д. 2

Anatoly I. Khavkin, Dr. Sci. (Med.), Professor, Head of the Moscow Regional Center for Pediatric Gastroenterology and Hepatology, Research Clinical Institute of Childhood; Chief Researcher of the Department of Gastroenterology of the Research Clinical Institute of Pediatrics named after Acad. Yu.E. Veltishchev, Professor of the Department of Pediatrics with a Course of Pediatric Surgical Diseases, Pirogov Russian National Research Medical University

62, Bolshaya Serpukhovskaya St., Moscow, 115093,

2, Taldomskaya St., Moscow, 125412

gastropedclin@gmail.comhttps://orcid.org/0000-0001-5214-8072ОдинаеваН. Д.OdinaevaN. D.

Одинаева Нуринисо Джумаевна, доктор медицинских наук, профессор, директор

115093, Москва, ул. Большая Серпуховская, д. 62

Nuriniso D. Odinaeva, Dr. Sci. (Med.), Professor, Director

62, Bolshaya Serpukhovskaya St., Moscow, 115093

nig05@mail.ruhttps://orcid.org/0000-0003-0596-635XСолнышкоА. Л.SolnyshkoA. L.

Солнышко Андрей Леонидович, кандидат медицинских наук, ассистент кафедры анестезиологии, реаниматологии и интенсивной терапии, Сибирский государственный медицинский университет; врач – анестезиолог-реаниматолог, заместитель главного врача по лечебной работе, Детская городская больница №1

34050, Томск, Московский тракт, д. 2,

634050, Томск, Московский тракт, д. 4

Andrey L. Solnyshko, Cand. Sci. (Med.), Assistant of the Department of Anesthesiology, Resuscitation and Intensive Care, Siberian State Medical University; Anesthesiologist-Resuscitator, Deputy Chief Physician for Medical Work, Children’s City Hospital No. 1

2, Moskovsky Trakt, Tomsk, 634050,

4, Moskovsky Trakt, Tomsk, 634050

a.soln_73@mail.ruhttps://orcid.org/0000-0002-7079-7356ГоликоваЕ. В.GolikovaЕ. V.

Голикова Елена Владимировна, кандидат медицинских наук, доцент кафедры госпитальной педиатрии, Сибирский государственный медицинский университет; старший научный сотрудник отдела наследственных и метаболических заболеваний, Научноисследовательский клинический институт детства

634050, Томск, Московский тракт, д. 2,

115093, Москва, ул. Большая Серпуховская, д. 62

Elena V. Golikova, Cand. Sci. (Med.), Associate Professor of the Department of Hospital Pediatrics, Siberian State Medical University; Senior Researcher, Department of Hereditary and Metabolic Diseases, Research Clinical Institute of Childhood

2, Moskovsky Trakt, Tomsk, 634050,

62, Bolshaya Serpukhovskaya St., Moscow, 115093

golikova1504@bk.ruСибирский государственный медицинский университет; Научно-исследовательский клинический институт детстваРоссияSiberian State Medical University; Research Clinical Institute of ChildhoodRussian FederationСибирский государственный медицинский университетРоссияSiberian State Medical UniversityRussian FederationОбластной дом ребенкаРоссияRegional Children’s HomeRussian FederationНаучно-исследовательский клинический институт детства; Медико-генетический научный центр имени академика Н.П. БочковаРоссияResearch Clinical Institute of Childhood; Medical Genetic Research Center named after Acad. N.P. BochkovRussian FederationНаучно-исследовательский клинический институт детства; Российский национальный исследовательский медицинский университет имени Н.И. ПироговаРоссияResearch Clinical Institute of Childhood; Pirogov Russian National Research Medical UniversityRussian FederationНаучно-исследовательский клинический институт детстваРоссияResearch Clinical Institute of ChildhoodRussian FederationСибирский государственный медицинский университет; Детская городская больница №1РоссияSiberian State Medical University; Children’s City Hospital No. 1Russian Federation202318112023020180188Copyright © Лошкова Е.В., Ребриенко М.В., Дорошенко И.В., Люлька Т.С., Будкин А.В., Рафикова Ю.С., Кондратьева Е.И., Хавкин А.И., Одинаева Н.Д., Солнышко А.Л., Голикова Е.В., 20232023Лошкова Е.В., Ребриенко М.В., Дорошенко И.В., Люлька Т.С., Будкин А.В., Рафикова Ю.С., Кондратьева Е.И., Хавкин А.И., Одинаева Н.Д., Солнышко А.Л., Голикова Е.В.Loshkova E.V., Rebrienko M.V., Doroshenko I.V., Lyulka T.S., Budkin A.V., Rafikova Y.S., Kondratyeva E.I., Khavkin A.I., Odinaeva N.D., Solnyshko A.L., Golikova Е.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/7916

Общеизвестно, что COVID-19, вызванный вирусом SARS-CoV-2 и характеризующийся острым респираторным синдромом с высокой заболеваемостью и смертностью, стремительно распространился по миру, приняв характер пандемии. Вирус поражает не только дыхательные пути, но и другие органы из-за механизмов цитокинового шторма, гипоксического повреждения, иммунного механизма и механизма с участием ангиотензин-превращающего фермента. Частота ассоциированного с COVID-19 церебрального венозного тромбоза (ЦВТ), с одной стороны, невелика и составляет менее 0,02%, однако, с другой стороны, этот показатель в 30–60 раз превышает частоту ЦВТ у лиц без COVID-19 (0,0003–0,0004% – у взрослых и 0,0007% – у детей). В отношении отдельно взятого пациента крайне важно, что сочетание ЦВТ и COVID-19 ассоциировано с более высоким уровнем смертности (45,5%), в отличие от ЦВТ (15%) и COVID-19 (5,6%) по отдельности. В представленном клиническом наблюдении и литературном обзоре авторы делают акцент на патофизиологических механизмах развития ассоциированного с COVID-19 ЦВТ для более глубокого и целостного представления о патологическом процессе, происходящем в организме, с целью формирования и совершенствования клинического мышления врачей-специалистов и приводят собственное клиническое наблюдение в качестве иллюстрации сложностей диагностики ассоциированного с COVID-19 ЦВТ. Авторы надеются, что настоящий обзор литературы с описанием клинического случая является ценным с точки зрения практикоприменимости как для клиницистов различных направлений, так и для научных сотрудников.

It is well known that COVID-19, caused by the SARS-CoV-2 virus and characterized by an acute respiratory syndrome with a high morbidity and mortality had rapidly spread around the world, taking on the character of a pandemic. The virus affects not only the respiratory tract, but also other organs due to mechanisms of the cytokine storm mechanism, in addition, hypoxic damage, immune mechanism and the mechanism involving angiotensin-converting enzyme. The frequency of CVT associated with COVID-19 is less than 0.02%, on the one hand, is low, but on the other hand, this rate is 30–60 times higher than the frequency of CVT in persons without COVID-19 (0.0003–0.0004% in adults and 0.0007% in children). For an individual patient, it is extremely important that the combination of CVT and COVID-19 is associated with a higher mortality rate (45.5%) in contrast to CVT (15%) and COVID-19 (5.6%) separately. In the presented literature review, the authors focus on the pathophysiological mechanisms of the development of COVID-19 associated cerebral thrombosis for a deeper and more holistic view of the pathological process occurring in the body in order to form and improve the clinical thinking of specialist doctors, and cite their own clinical observation as an illustration of the difficulties of diagnosing COVID-19 associated cerebral thrombosis. The authors believe that this review of the literature describing a clinical case is valuable from the point of view of practical applicability, both for clinicians of various fields and for researchers.

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