Взгляд токсикологов на механизмы формирования вирусиндуцированных гемоглобинопатий и токсического пневмонита с системной гипоксемией при COVID-19 и обоснование рациональных методов детоксикации

  • Авторы: Н.Г. Проданчук, Г.М. Балан, Н.В. Курдиль, П.Г. Жминько, Н.Н. Бубало, Д.Д. Дячук, А.П. Кравчук
  • УДК: 578.76:616.24-001:616.152.21:612.398.145.2+615.273
  • DOI: 10.33273/2663-4570-2020-88-1-5-22 (english), 10.33273/2663-4570-2020-88-1-23-41 (українська)

Н.Г. Проданчук1, Г.М. Балан1, Д.Д. Дячук2, А.П. Кравчук1, Н.В. Курдиль1, П.Г. Жминько1, Н.Н. Бубало2

1ГП «Научный центр превентивной токсикологии, пищевой и химической безопасности имени академика Л.И. Медведя Министерства здравоохранения Украины», г. Киев, Украина
2Государственное научное учреждение «Научно-практический центр профилактической и клинической медицины» Государственного управления делами, г. Киев, Украина

РЕЗЮМЕ. Коронавирусная болезнь COVID-19 в настоящее время является глобальной проблемой для человечества, приобретя характер пандемии. С позиции токсикологов назрела необходимость обобщить литературные данные о патогенетических и патофизиологических механизмах формирования основных клинических проявлений COVID-19 и обосновать пути оптимизации лечебных стратегий с использованием детоксикационной терапии.

Цель работы. На основании анализа литературных данных выделить патогенетические механизмы формирования основных клинических синдромов COVID-19, обобщить результаты клинико-лабораторных исследований, клинические и гематологические критерии прогнозирования тяжелого течения со смертельным исходом при данной патологии и обосновать пути оптимизации детоксикационной терапии.

Материал и методы. Аналитический обзор научных публикаций выполнен с использованием реферативных баз данных научных библиотек PubMed, Medline и текстовых баз данных научных издательств Elsevier, PubMed Central, BMJ Group и других VIP-баз данных и охватывает период с 1 января 2020 по 30 апреля 2020. Использованы методы системного, сравнительного и контент-анализа.

Результаты и выводы. Осуществлен анализ публикаций по выявлению путей инфицирования вирусом SARS-CoV-19, механизмов формирования клинических проявлений различных вариантов течения COVID-19 для выделения наиболее информативных предикторов развития тяжелых форм заболевания, приводящих к летальному исходу. Обобщены литературные данные о механизмах развития виремии SARS-CoV-19, определены патогенетические и патофизиологические механизмы формирования вирусиндуцированных гемоглобинопатий, токсического пневмонита, системной гипоксемии, гиперферри-тинемии, цитокиновой «бури», окислительного стресса и эндотоксикоза при COVID-19 и обоснованы пути оптимизации детоксикационной терапии с включением эфферентных методов лечения, комплексобразующих средств для вывода избыточных уровней железа и ферритина, антиоксидантов и антигипоксантов, кислородной терапии и трансфузии иммунной плазмы реконвалесцентов, компонентов донорской крови и стволовых клеток.

Ключевые слова: коронавирусная болезнь; COVID-2019; вирусиндуцированные гемоглобинопатии, пневмонит, детоксикационная терапия.

 

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Received 04/17/2020