Патогенез нейропсихических осложнений при коронавирусной инфекции (COVID-19)



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У значительного числа больных инфекция, вызываемая коронавирусом SARS-Cov-2, характеризуется неврологическими и психическими осложнениями, в основе которых лежат нарушение проницаемости гематоэнцефалического барьера, проникновение в головной мозг провоспалительных цитокинов, нейровоспаление и коагулопатия. Патологоанатомические исследования головного мозга пациентов, умерших в острый период заболевания, показали наличие очагов периваскулярного воспаления, содержащих макрофаги и, в небольшом количестве, CD8+Т-клетки. В развитии нейровоспаления участвуют клетки микроглии, тучные клетки, макрофаги, эндотелиоциты. В образцах мозговой ткани наблюдались узелки микроглии, указывающие на нейрофагию и потерю нейронов. Некоторые белки SARS-Cov-2, в частности, белок S, обладают патогенными свойствами по отношению к нейронам. Биохимические маркеры в спинномозговой жидкости больных COVID-19 - NfL (легкая цепь нейрофиламентов) и GFAР (глиальный фибриллярный кислый белок) указывают на разрушение аксонов и повреждение астроцитов. У многих больных COVID-19 вследствие иммунной дисфункции и молекулярной мимикрии обнаруживаются аутоантитела к собственным антигенам, в том числе к некоторым рецепторам ЦНС, и энцефалиты. У пациентов с болезнью Альцгеймера и болезнью Паркинсона коронавирусная инфекция усиливает симптомы данных заболеваний. Целью обзора является обобщение имеющихся в литературе данных для анализа иммунопатогенеза нейропсихических осложнений острой коронавирусной инфекции (COVID-19) и постковидного синдрома.

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Об авторах

Николай Анатольевич Климов

ФГБНУ "Институт экспериментальной медицины"

Email: nklimov@mail.ru
ORCID iD: 0000-0002-5243-8085

старший научный сотрудник

Россия

Ольга Валерьевна Шамова

Институт экспериментальной медицины

Автор, ответственный за переписку.
Email: oshamova@yandex.ru
ORCID iD: 0000-0002-5168-2801

Доцент, доктор биологических наук, член-корреспондент РАН, заведующий отделом общей патологии и патологической физиологии

Россия

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