Постковидный синдром: распространенность и патогенез органных поражений, направления коррекции. Систематический обзор

Введение. Продолжающаяся пандемия COVID-19 сопровождается быстрым ростом количества людей, перенесших инфекцию SARS-CoV-2 и имеющих ряд сохраняющихся полиорганных поражений с широким спектром стойких симптомов и/или отсроченных осложнений. Важно оценить требующийся объем мероприятий системы здравоохранения по их диагностике и лечению, реабилитации пациентов.

Цель — собрать и систематизировать накопленную за последнее время информацию об эпидемиологии, патофизиологии органоспецифических последствиях COVID-19 и направлениях их коррекции.

Методы. Проведен поиск литературных источников в базах данных eLibrary и MEDLINE/PubMed по ключевым словам «постковидный синдром» и «COVID-19», «SARS-CoV-2», «post-covid syndrome», «organ lesions», «pathogenesis», «treatment» с выбором типов статей «Clinical Trial», «Meta-Analysis», «Review», «Systematic Review», опубликованных за период с 1 января 2020 по 10 июля 2021 года на английском и русском языках. Для включения в обзор рассматривались исследования любого дизайна, отражающие современные представления об эпидемиологии, патогенезе, поздних проявлениях и осложнениях перенесенного COVID-19 со стороны органов и систем, направлениях их коррекции. Предпочтение при выборе публикаций отдавали полнотекстовым статьям в рецензируемых журналах, имеющих высокий импакт-фактор.

Результаты. После скрининга 1163 источников литературы отобраны и проанализированы 480 наиболее значимых статей, доступных в полнотекстовом формате, в обзор вошла 131 из них. За 2020–2021 гг. опубликован ряд исследований стойких проявлений COVID-19. Среди них, как правило, упоминаются легочные, сердечно-сосудистые, почечные осложнения, гематологические расстройства, нейропсихиатрические, эндокринные последствия. Менее изучены желудочно-кишечные, гепатобилиарные и дерматологические осложнения инфекции SARS-CoV-2. Формируются представления о патогенезе поражений органов и систем организма, сохраняющихся в течение недель и месяцев после острой фазы COVID-19. Понимание этих патофизиологических процессов позволит врачам проводить целенаправленные мероприятия по комплексному лечению постковидного синдрома. В настоящее время проводятся клинические исследования, которые обеспечат доказательную базу профилактики и терапии осложнений COVID-19 после выписки из стационара.

Заключение. Ведение пациентов с COVID-19 не завершается при выписке из стационара, и многим из них требуется комплексная междисциплинарная медицинская помощь в амбулаторных условиях. Активный процесс накопления базы данных и профессиональной информации о постковидном синдроме закладывает основы успешного лечения и реабилитации пациентов, перенесших COVID-19.

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