emcardioНеотложная кардиология и кардиоваскулярные рискиEmergency Cardiology and Cardiovascular Risks journal2616-633XБелорусский государственный медицинский университет10.51922/2616-633X.2022.6.2.1661emcardio-79Research ArticleОригинальные научные публикацииOriginal Scientific ResearchОсобенности лабораторных показателей воспаления и тромбоза у пациентов с новой коронавирусной инфекцией SARS-CoV-2 и тромбоэмболией легочной артерииCertain features of laboratory markers of inflammation and thrombosis in patients with new coronavirus infection SARS-CoV-2 and pulmonary embolismПлешкоА. А.PleshkoА. А.

г. Минск

Minsk

Учреждение образования «Белорусский государственный медицинский университет»,Belarusian State Medical University2022230620256216611665Copyright © Плешко А.А., 20252025Плешко А.А.Pleshko А.А.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://emcardio.bsmu.by/jour/article/view/79

Введение. Пандемия COVID-19 продолжается – во всем мире по данным ВОЗ было зафиксировано более 600 млн случаев данного заболевания, а также более 6 млн смертей. Состояние гиперкоагуляции является ключевой особенностью течения COVID-19, которое нередко приводит к развитию серьезных сердечно-сосудистых событий и неблагоприятных исходов. В группе лиц с тромботическими осложнениями на фоне COVID-19 отмечается более высокий риск смертности от всех причин, а смертность среди пациентов с COVID-19 и ТЭЛА значительно выше, чем у пациентов только с одним из этих состояний, что свидетельствует об угрожающем жизни аддитивном эффекте комбинации COVID-19 и ТЭЛА. Таким образом, необходимо дальнейшее изучение особенностей показателей воспаления и тромбоза у пациентов с COVID-19, учитывая высокую распространенность тромботических осложнений среди данной группы пациентов.Цель. Определить особенности показателей лабораторных маркеров воспаления и тромбоза у лиц с COVID-19 и развившейся тромбоэмболией легочной артерии.Материалы и методы. В исследование включено n = 116 пациентов с COVID-19, госпитализированных в УЗ «4-я ГКБ им. Н.Е. Савченко», у которых развилось тромботическое событие – ТЭЛА. Средний возраст пациентов составил 64,7 ± 11,3 лет, среди них число мужчин – 53 (45,7%) и женщин – 63 (54,3%) соответственно. Исследуемую группу составили пациенты с COVID-19 и подтвержденным диагнозом ТЭЛА (n = 37), группу сравнения – пациенты с COVID-19 без ТЭЛА (n = 79). Пациенты в группах были сопоставимы по полу, возрасту, наличию традиционных факторов риска, степени тяжести COVID-19. Были проанализированы ассоциированные с тромбозом показатели общего анализа крови, коагулограммы, биохимического анализа крови на момент подтверждения либо исключения ТЭЛА с помощью компьютерной томографической ангиографии легочных артерий.Результаты. В результате межгруппового сравнения лабораторных показателей в группе пациентов с COVID-19 и подтвержденным диагнозом ТЭЛА в сравнении с группой пациентов с COVID-19 без ТЭЛА было достоверно выше среднегрупповое количество лейкоцитов: 10,59 (6,75–12,6)×109/л против 7,12 (4,50–9,08)×109/л (U = 96,5; р < 0,05); достоверно выше среднегрупповой уровень С-реактивного белка (СРБ): 120,09 (45,08–164,38) мг/л против 54,89 (31,14–96,86) мг/л (U = 101,0; р < 0,05), были достоверны выше среднегрупповые показатели фибриногена и Д-димера: 7,03 (5,89–8,28) г/л против 5,98 (4,25–6,80) г/л (U = 99,0; р < 0,05) и 2058,5 (826,0–4026,0) нг/мл против 982,5 (656,5–1936,0) нг/мл (U = 141,5; p < 0,05) соответственно, выявлен более высокий удельный вес лиц с повышенным значением протромбинового времени: 75,5% (n = 28) против 32,9% (n = 26) (χ2 = 6,31; p < 0,05). У пациентов с COVID-19 и ТЭЛА установлена прямая средней силы связь между значениями СРБ и Д-димера (ρ = 0,66; p < 0,05), прямая средней силы связь между значениями значениями СРБ и фибриногена (ρ = 0,61; p < 0,05).Заключение. У пациентов с новой коронавирусной инфекцией COVID-19 и ТЭЛА заболевание протекает на фоне выраженного увеличения содержания маркеров воспаления и тромбоза (числа лейкоцитов, СРБ, фибриногена, Д-димера). Связь между значениями СРБ, фибриногена, Д-димера свидетельствует об ассоциации воспаления с уровнем маркеров тромбоза.

Introduction. The COVID-19 pandemic continues with over 600 million cases and over 6 million deaths worldwide according to WHO. The state of hypercoagulation is a key feature of the course of COVID-19 which often leads to the development of serious cardiovascular events and adverse outcomes. There is a higher risk of all-cause mortality in the COVID-19 cohort with thrombotic complications, and mortality among patients with COVID-19 and PE is significantly higher than in patients with either condition alone, indicating a life-threatening additive effect of the combination of COVID-19 and PE. Thus, it is necessary to study further the features of inflammation and thrombosis parameters in patients with COVID-19 given the high prevalence of thrombotic complications among this group of patients.Objective. To define features of inflammation and thrombosis laboratory markers in patients with COVID-19 and pulmonary embolism.Materials and Methods. The study included n = 116 patients with COVID-19 hospitalized in 4-th city clinical hospital of Minsk named after N.E. Sauchenko in whom a thrombotic event – pulmonary embolism (PE) – was developed. The mean age of the patients was 64.7 ± 11.3 years, with 53 (45.7%) male and 63 (54.3%) female patients, respectively. The study group consisted of patients with COVID-19 and confirmed diagnosis of PE (n = 37) and the comparison group consisted of patients with COVID-19 without PE (n = 79). Patients in the groups were comparable by sex, age, presence of traditional risk factors, and COVID-19 severity. The parameters associated with thrombosis were analyzed in general blood count, hemostasiogram, biochemical blood analysis at the moment of confirmation or exclusion of PE using computer tomographic angiography of the pulmonary arteries.Results. Intergroup comparison of laboratory parameters in the group of patients with COVID-19 and confirmed diagnosis of PE in comparison with the group of patients with COVID-19 without PE showed a significantly higher mean group leukocyte count: 10,59 (6,75–12,6)×109/L versus 7,12 (4,50–9,08)×109/L (U = 96,5; p < 0,05); significantly higher mean group level of C-reactive protein (CRP): 120.09 (45.08–164.38) mg/L versus 54.89 (31.14–96.86) mg/L (U = 101.0; p < 0.05); group mean fibrinogen and D-dimer were significantly higher: 7.03 (5.89–8.28) g/L versus 5.98 (4.25–6.80) g/L (U = 99.0; p < 0.05) and 2058.5 (826.0–4026.0) ng/mL versus 982.5 (656.5–1936.0) ng/mL (U = 141.5; p < 0.05) respectively. A higher proportion of individuals with increased prothrombin time was identified: 75.5% (n = 28) versus 32.9% (n = 26) (χ2 = 6.31; p < 0.05). In patients with COVID-19 and PE there was a direct moderate relationship between CRP and D-dimer values (ρ = 0.66; p < 0.05), a direct moderate relationship between CRP and fibrinogen values (ρ = 0.61; p < 0.05).Conclusion. Patients with new coronavirus infection COVID-19 and PE had a marked increase of inflammatory and thrombotic markers (leukocyte count, CRP, fibrinogen, D-dimer). The relationship between the values of CRP, fibrinogen, D-dimer indicates the association of inflammation with the thrombosis markers level.

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