jofinЖурнал инфектологииJournal Infectology2072-6732IPO “АIDSSPbR"10.22625/2072-6732-2022-14-2-27-38jofin-1350Research ArticleОбзорReviewОжирение и COVID-19: инсайты двух пандемийObesity and COVID-19: insights from two pandemicsХалимовЮ. Ш.KhalimovYu. Sh.

Халимов Юрий Шавкатович – начальник кафедры военно-полевой терапии; д.м.н., профессор; тел.: +7-921-941-18-56

Санкт-Петербург

Saint-Petersburg

yushkha@gmail.comАгафоновП. В.AgafonovP. V.

Агафонов Павел Владимирович – докторант при кафедре военно-полевой терапии; к.м.н.; тел.: +7-911-275-24-48

Санкт-Петербург

Saint-Petersburg

mveda-nio@mil.ruКирееваЕ. Б.KireevaE. B.

Киреева Елена Борисовна – доцент кафедры военно-полевой терапии; к.м.н.; тел.: +7-921-915-62-80

Санкт-Петербург

Saint-Petersburg

kirr72@mail.ruВоенно-медицинская академия им. С.М. КироваРоссияMilitary Medical Academy named after S.M. KirovRussian Federation2022130720221422738Copyright © Халимов Ю.Ш., Агафонов П.В., Киреева Е.Б., 20222022Халимов Ю.Ш., Агафонов П.В., Киреева Е.Б.Khalimov Y.S., Agafonov P.V., Kireeva E.B.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.niidi.ru/jofin/article/view/1350

В настоящей обзорной статье обсуждаются патофизиологические механизмы развития коронавирусной инфекции у пациентов с ожирением. Показано, что ожирение рассматривается как важнейший фактор риска для развития множества коморбидных заболеваний, в том числе тяжелых форм и смертельных исходов в результате новой коронавирусной инфекции. В основе более высокой частоты встречаемости и тяжести течения новой коронавирусной инфекции у пациентов с ожирением лежит комплекс факторов, главными из которых являются увеличение сердечно-сосудистого риска, в том числе склонность к тромбозам, снижение эффективности дыхательной системы, нарушение иммунного ответа, а также наличие хронического воспалительного состояния. В статье рассмотрены немедикаментозные подходы и вопросы фармакологической терапии у пациентов с ожирением в условиях пандемии новой коронавирусной инфекции. Показано, что проведение национальных карантинных мероприятий привело к повышению гиподинамии, уровню стресса и изменению пищевого поведения населения, замыкая порочный круг и способствуя повышению массы тела. По этой причине усилия врачей терапевтических специальностей должны быть направлены, в первую очередь, на повышение устойчивости к инфекции среди больных ожирением и борьбу с гиподинамией. Перечислены основные группы лекарственных препаратов, которые могут быть использованы для борьбы с липотоксичностью. Отмечено, что врачи-инфекционисты и эндокринологи могут использовать те группы препаратов, которые влияют на наиболее уязвимые патогенетические триггеры развития ожирения и сопутствующей патологии: процессы голода и насыщения, снижение чувствительности к инсулину, развитие липотоксичности и хронического воспаления. Доказано, что спектр позитивных эффектов новых антигипергликемических препаратов из групп агонистов глюкогоноподобного пептида 1 типа и ингибиторов натрий-глюкозного контранспортера 2 типа в сочетании с хорошо изученным профилем эффективности и безопасности представляет новую возможность для лечения ожирения в условиях пандемии коронавирусной инфекции.

This review article discusses the pathophysiological mechanisms of the development of coronavirus infection in obese patients. It has been shown that obesity is considered as the most important risk factor for the development of many comorbid diseases, including severe forms and deaths as a result of a new coronavirus infection. The higher incidence and severity of a new coronavirus infection in obese patients is based on a complex of factors, the main of which are an increase in cardiovascular risk, including a tendency to thrombosis, a decrease in the efficiency of the respiratory system, impaired immune response, and the presence of chronic inflammatory state. The article discusses non-drug approaches and issues of pharmacological therapy in patients with obesity in the context of a pandemic of a new coronavirus infection. It is shown that the implementation of national quarantine measures has led to an increase in physical inactivity, the level of stress and a change in the eating behavior of the population, closing a vicious circle and contributing to an increase in body weight. For this reason, the efforts of physicians of therapeutic specialties should be directed primarily to increasing resistance to infection among obese patients and combating physical inactivity. The main groups of drugs that can be used to combat lipotoxicity are listed. It was noted that infectious disease doctors and endocrinologists can use those groups of drugs that affect the most vulnerable pathogenetic triggers for the development of obesity and comorbidities: hunger and satiety processes, decreased insulin sensitivity, development of lipotoxicity and chronic inflammation. It has been proven that the range of positive effects of new antihyperglycemic drugs from the groups of type 1 glucagon-like peptide agonists and type 2 sodium-glucose transporter inhibitors, combined with a well-studied efficacy and safety profile, represents a new opportunity for the treatment of obesity in the context of a coronavirus infection pandemic.

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