Постковидный синдром у больных сахарным диабетом 2-го типа: определение, эпидемиология, патофизиология, биомаркеры и генетические ассоциации

В статье приводятся современные представления о постковидном синдроме, дается его определение, указываются его различные типы и классификации, эпидемиологические данные, в том числе среди больных сахарным диабетом 2-го типа. Группа пациентов с постковидным синдромом весьма неоднородна: синдром чаще встречается у пожилых, с коморбидной патологией, тяжелым течением. Рассмотрена патофизиология данного синдрома у больных сахарным диабетом 2-го типа, указаны факторы риска. Определены основные биомаркеры нарушений: моноциты и их коэффициенты, белки острой фазы, дислипидемия, некоторые биохимические показатели, включая разбор генетических ассоциаций с выраженностью постковидных нарушений (гена гамма-интерферона, гена метилентетрагидрофолатредуктазы, ингибитора ангиотензинпревращающего фермента 2). Генотипирование отобранных 26 однонуклеотидных полиморфизмов генов, ответственных за проникновение вируса, иммунный ответ и воспаление, были значимо связаны не только с риском долгосрочных симптомов COVID-19, но и с кумулятивной частотой возникновения постковидного синдрома. Повышенный уровень интерлейкина 6, С-реактивного белка и фактора некроза опухоли альфа может служить потенциальным диагностическим биомаркером при длительном течении COVID. Биомаркеры сосудистой трансформации крови имеют большой потенциал в диагностике, а модуляторы ангиогенеза могут иметь терапевтическую эффективность. Показано, что у подавляющего большинства пациентов, в частности страдающих сахарным диабетом 2-го типа, развивается постковидный синдром, а с учетом ранее существовавших заболеваний он не столь безобиден. Путем выделения общих биомаркеров и генетических ассоциаций возможно выявить общий молекулярный механизм постковидного синдрома и сахарного диабета. Новизна изучения ассоциаций болезней в контексте COVID-19 позволяет по-новому взглянуть на ведение быстроразвиваю щихся длительных синдромов COVID и пост-COVID, которые имеют серьезные глобальные последствия.

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