Синдром активации макрофагов при COVID-19

COVID-19 – инфекционное заболевание, вызываемое бета-коронавирусом SARS-CoV-2, которое получило распространение по всему миру в 2020 г. Эпидемия нового коронавируса характеризуется высокими показателями заболеваемости и относительно высокой смертностью. В большинстве тяжелых случаев клиническая картина характеризуется не только лихорадкой, кашлем и другими конституциональными симптомами, но также гиперцитокинемией, дыхательной недостаточностью и в конечном итоге может привести к смерти. Среди лабораторных данных можно выделить лейкопению, повышение функциональных проб печени и уровень ферритина, достигающий сотен, а иногда и тысяч единиц. Совокупность этих данных напоминает нам о синдроме активации макрофагов (САМ). Синдром вторичного гемофагоцитарного лимфогистиоцитоза, САМ – это состояние, которое развивается у пациентов с инфекционными и ревматологическими заболеваниями, а также у пациентов со злокачественными новообразованиями. Основу патогенеза составляет дефект механизмов Т-клеточной цитотоксичности и снижение уровня естественных киллеров, сопряженных с дефектом в гене, кодирующем перфорин, а также гиперпродукция Т-лимфоцитами и гистиоцитами ряда цитокинов – интерлейкина (IL)-1â, фактора некроза опухоли aльфа и др., опосредованно ведущих к активации макрофагов и продукции провоспалительных цитокинов, в частности гиперпродукции IL-6. САМ входит в комплекс «гиперферритинемических синдромов», также как катастрофический антифосфолипидный синдром, болезнь Стилла и септический шок. Эти расстройства имеют сходные клинические и лабораторные проявления, и они также отвечают на аналогичные методы лечения, предполагая, что гиперферритинемия может быть вовлечена в общий патогенез. Все вышеперечисленные состояния характеризуются повышенным уровнем ферритина и цитокиновым штормом.

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