Возможности иммунотерапии в лечении COVID-19

Достаточно высокую смертность при COVID-19 можно объяснить развитием гипервоспалительного синдрома, характеризующегося цитокиновым штормом и обширным тромбообразованием. Основным направлением по предотвращению развития гипервоспалительного синдрома и по снижению летальности от COVID-19 является иммунная терапия, однако данные об эффективности и критериях назначения иммунных препаратов весьма разнородны. Целью данного обзора является анализ результатов клинических исследований по применению различных видов иммунной терапии при COVID-19 и возможных критериев ее назначения. Анализ литературных данных показал, что из существующих вариантов иммунной терапии наиболее эффективными оказались моноклональные антитела к IL-6, а также использование плазмы доноров на ранних этапах лечения. Ингибиторы янус-киназы, внутривенный иммуноглобулин способствовали улучшению клинического состояния пациентов, однако не влияли на уровень смертности. Авторами статьи был проведен анализ возможных маркеров предикторов развития цитокиновгого шторма. Наибольшую информативность и доступность в клинической практике на данный момент показали повышение количества нейтрофилов > 11 × 10³/мл, снижение количества лимфоцитов > 1000 × 10³/мл, повышение уровня IL-6 > 24 пг/мл, лактатдегидрогеназы > 300 МЕ/л, Д-димера > 1000 нг/мл и С-реактивного белка > 10 мг/дл.

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