Abstract
Abstract
The COVID-19 coronavirus pandemic caused by the SARS-CoV-2 virus has led to far-reaching consequences. The changes it causes in the macroorganism can persist for more than 6-12 months after the acute phase of the disease, forming post-COVID disorders of the immune system. Patients who have had acute COVID-19 in both mild and severe forms suffer from various manifestations of post-COVID syndrome. However, the severity of these manifestations is very variable.
The aim of the study was to assess the effect of the degree of lung damage in the acute period of COVID-19 on the severity of clinical manifestations of post-COVID syndrome using the example of immune-mediated symptom complexes: autoimmune, proliferative, and allergopathology.
Materials and methods of research: 131 patients who had suffered from SARS-CoV-2 infection were examined. Anamnestic data from outpatient cards of patients were used for the study. Using the ELISA diagnostics method, IgA, IgM, IgG, complement fragments C1q, C3a, C5a specific to SARS-CoV-2 were determined.
The studies revealed a connection between the severity of post-COVID syndrome and the severity of the acute course of COVID-19. The SARS-CoV-2 virus is capable of activating complement, and this activation persists for a long time (more than six months), which explains the presence of clinical manifestations of post-COVID syndrome in individuals who have had a mild acute form of COVID-19 without lung damage according to computed tomography data and who do not have the phenotypes of immune system damage that we have previously identified (congenital - decreased expression of CD46 on T-lymphocytes and decreased expression of CD46 on NK cells, and acquired - decreased level of T-cytotoxic lymphocytes and impaired level of B-cells CD45+CD3-CD19+CD5+CD27+).
The data obtained indicate that the examination of post-COVID patients should be carried out not only by assessing their clinical characteristics, but also by examining the state of the immune system of such patients in order to make a correct diagnosis and prescribe etiological and pathogenetic therapy, including immune therapy.
Conclusions.
Autoimmune, proliferative and allergic diseases are directly related to disorders of the immune system. Summarizing the results of this study, we can make the following conclusions:
- The severity of autoimmune disorders in the post-COVID period is not directly related to the severity of the disease, but is more associated with basic corticosteroid therapy (GCS) both for the treatment of autoimmune processes and for the treatment of COVID-19. If GCS are not used for autoimmune thyroiditis, then their use in the acute period of infection subsequently reduced the number of relapses. Whereas with rheumatoid arthritis, the situation is the opposite: the use of GCS in the acute period of infection in patients already on basic corticosteroid therapy subsequently leads to an increase in the number of relapses in post-COVID patients.
- In post-COVID patients, a tendency towards an increase in the most clinically severe allergopathology was revealed: firstly, in all groups (52%) in the post-COVID period, exacerbations of such pathologies as Quincke's edema, urticaria, anaphylaxis, vasculitis, alveolitis, and bronchiolitis became more frequent. All this indicates that the deterioration of the condition of these patients in the post-COVID period was influenced by the past infection caused by the SARS-CoV-2 virus. Allergic skin lesions were in second place in terms of the frequency of exacerbations - about 28%.
- There is a tendency towards an increase in the frequency of exacerbations of proliferative diseases in patients with more severe forms of acute COVID-19 infection. It should also be noted that the percentage of such patients is quite high - from 31.6% to 48%.
- The SARS-CoV-2 virus can affect the activation of the complement system, which explains the presence of clinical manifestations of post-COVID syndrome in individuals who have had an acute form of COVID-19 in a mild form without lung damage according to computed tomography data and who do not have the phenotypes of immune system damage that we have previously identified. The data obtained indicate that the examination of post-COVID patients should be carried out not only by assessing their clinical characteristics, but also by examining the state of the immune system of such patients in order to make a correct diagnosis and prescribe etiological and pathogenetic therapy, including immune therapy.
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СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).