Отдаленные осложнения COVID-19 c поражением легких
ПЕРЕДОВАЯ СТАТЬЯ
Аннотация
Фиброз легких является одним из наиболее опасных долгосрочных осложнений COVID-19, особенно у пациентов с тяжелым течением заболевания. У части пациентов, перенесших тяжелый COVID-19, сохранялись снижение диффузионной емкости легких, нарушения вентиляции, фиброзоподобные изменения легочной ткани, хроническая одышка и хроническая усталость. Механизмы развития легочного фиброза включают в себя активацию нескольких сигнальных путей (TGF-β, Wnt/β-catenin, YAP/TAZ) и процесс эпителиально-мезенхимального перехода. Трансформирующий фактор роста (TGF-β) играет центральную роль в развитии фиброза. Усиление TGF-β-сигналинга связано с апоптозом клеток альвеолярного эпителия, активацией фибробластов и образованием миофибробластов, индукцией эпителиально-мезенхимального перехода, развитием фиброзных изменений легких и является мощным стимулятором фиброза. Частота возникновения фиброза легких после COVID-19 положительно коррелирует с тяжестью заболевания в острой фазе. Ранняя диагностика, комплексное лечение и реабилитация играют важную роль в улучшении прогноза для пациентов с этими осложнениями. Имеются данные о том, что противовоспалительная и антифибротическая терапия, направленная на подавление TGF-β, может быть эффективной для профилактики и снижения выраженности фиброза. В нашем обзоре приведены методы профилактики, диагностики и лечения пост-COVID-легочного фиброза. Однако в связи с распространенностью и высокой летальностью COVID-19-индуцированного легочного фиброза и низкой эффективностью антифибротических препаратов актуальна разработка таргетных методов лечения, основанных на биомаркерах и молекулярных механизмах заболевания. Для лучшего понимания патогенеза, выявления и использования специфических биомаркеров для диагностики, прогноза, новых методов лечения и профилактики пост-COVID-легочного фиброза необходимы дальнейшие исследования.
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