jofinЖурнал инфектологииJournal Infectology2072-6732IPO “АIDSSPbR"10.22625/2072-6732-2025-17-3-24-32jofin-1833Research ArticleОБЗОРREVIEWИммунная дисрегуляция при коронавирусной инфекции COVID-19Immune dysregulation in coronavirus infection COVID-19ЕвдокимоваА. Э.EvdokimovaA. E.

Евдокимова Арина Эдуардовна – аспирант кафедры детских инфекций.

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тел. +7-987-275-79-39

Kazan

tilai.ar@yandex.ruХаертыновХ. С.KhaertynovKh. S.

Хаертынов Халит Саубанович – доцент кафедры детских инфекций, д.м.н.

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тел.: +7-903-342-96-27

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khalit65@yandex.ruАнохинВ. А.AnokhinV. A.

Анохин Владимир Алексеевич – заведующий кафедрой детских инфекций, д.м.н., профессор.

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тел.: +7-903-306-33-70

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anokhin56@mail.ruРагиновИ. С.RaginovI. S.

Рагинов Иван Сергеевич – доцент кафедры общей патологии КГМУ; профессор кафедры профилактической медицины КФУ (ИФМиБ), д.м.н.

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raginovi@mail.ruКазанский государственный медицинский университетРоссияKazan State Medical UniversityRussian FederationКазанский государственный медицинский университет; Казанский федеральный университет (Институт фундаментальной медицины)РоссияKazan State Medical University; Kazan Federal University (Institute of Fundamental Medicine and Biology)Russian Federation2025220920251732432Copyright © Евдокимова А.Э., Хаертынов Х.С., Анохин В.А., Рагинов И.С., 20252025Евдокимова А.Э., Хаертынов Х.С., Анохин В.А., Рагинов И.С.Evdokimova A.E., Khaertynov K.S., Anokhin V.A., Raginov I.S.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/1833

Иммунная дисрегуляция является одной из ключевых причин развития тяжелых форм коронавирусной инфекции COVID-19. Иммунный ответ при COVID-19 характеризуется активацией клеток врожденного иммунитета с ростом в крови провоспалительных цитокинов – фактора некроза опухоли альфа, интерлейкинов-1,-6, -8, нейтрофилов, С-реактивного белка и ферритина. С синдромом «цитокинового шторма» ассоциируется дисфункция различных органов у пациентов с COVID-19, в том числе развитие острого респираторного дистресс-синдрома.

Другим клинически значимым проявлением дисрегуляции иммунного ответа при COVID-19 является лимфопения, один из ключевых предикторов развития тяжелых форм заболевания и неблагоприятного исхода. Одной из основных причин лимфопении у пациентов с COVID-19 является активация апоптоза лимфоцитов. Клиническое значение апоптоза лимфоцитов при тяжелых формах COVID-19 ассоциируется с риском формирования иммуносупрессии и развития вторичных инфекционных заболеваний. Развитие иммуносупрессии при тяжелых формах COVID-19 подтверждается результатами патоморфологических исследований, демонстрирующих снижение количетсва лимфоцитов в лимфоидной ткани. Еще одна значимая причина лимфопении – миграция лимфоцитов из крови в легкие. Постмортальные исследования легких пациентов, умерших от COVID-19, демонстрируют признаки лимфоцитарной инфильтрации. Еще одной причиной лимфопении может быть нарушение лимфопоэза вследствие вирус-индуцированного поражения предшественников лимфоцитов в костном мозге и тимусе. У пациентов с COVID-19 наблюдается значительное снижение образования Т-клеток тимуса. Снижение функции тимуса может усугубить лимфопению у пациентов с COVID-19 в острой фазе и увеличить время, необходимое для восстановления количества циркулирующих Т-клеток.

Immune dysregulation is one of the main causes of severe coronavirus infection COVID-19. The immune response in COVID-19 is characterized by the activation of innate immune cells and elevated levels of pro-inflammatory cytokines in the blood (tumor necrosis factor alpha, interleukins-1, -6, -8), neutrophils, C-reactive protein and ferritin. Organ dysfunction, including acute respiratory distress syndrome, is associated with cytokine storm. Another important sign of immune dysregulation is lymphopenia, one of the key predictor of the development of severe COVID-19 and poor outcome. One of the main causes of lymphopenia in patients with severe COVID-19 is apoptosis of lymphocytes. The increased proinflammatory cytokines play a critical role in the induction of lymphocytes apoptosis and lymphopenia. The clinical role of lymphocytes apoptosis in COVID-19 is associated with the immunosupression and the opportunistic and secondary infectious diseases. The immunosupression in severe COVID-19 is confirmed by the results of morphological studies demonstrating the depletion of lymphocytes in lymphoid tissue. Next important cause of lymphopenia is lymphocyte sequestration in the lungs. Postmortem studies of the lungs of patients died from COVID-19 show the lymphocytic infiltration. Additionally, lymphopenia may result from impaired lymphopoiesis due to virus-induced damage to lymphocyte precursors in the bone marrow and thymus. In COVID-19 patients, there is a significant reduction in the production of T-cells in the thymus. The decreased thymic function may exacerbate lymphopenia in patients during the acute phase of COVID-19 and prolong the time required for the recovery of circulating T-cell counts.

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