Иммунная дисрегуляция при коронавирусной инфекции COVID-19

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.

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