systhiperСистемные гипертензииSystemic Hypertension2075-082X2542-2189LLC «ИнтерМедсервис»10.38109/2075-082X-2022-4-37-44systhiper-645Research ArticleОБЗОРREVIEWЭндотелиальная дисфункция у больных COVID-19 – ключевой механизм развития осложненийEndothelial dysfunction in patients with COVID-19 is a key mechanism for the development of complicationshttps://orcid.org/0000-0002-4269-4608КокаеваИ. О.KokaevaI. O.

Кокаева Изольда Омаровна, врач-кардиолог, аспирант отдела гипертонии, Институт клинической кардиологии им. А.Л. Мясникова

ул. 3-я Черепковская, 15-А, Москва 121552

Izolda O. Kokaeva, cardiologist, Graduate Student, A.L. Myasnikov Institute of Clinical Cardiology

3rd Cherepkovskaya str., 15a, Moscow 121552

izolda.kokaeva@icloud.comhttps://orcid.org/0000-0001-7895-9068ЖернаковаЮ. В.ZhernakovaYu. V.

Жернакова Юлия Валерьевна, доктор медицинских наук, ученый секретарь Института клинической кардиологии им. А.Л. Мясникова

ул. 3-я Черепковская, 15-А, Москва 121552

Yuliya V. Zhernakova, Prof., Dr. of Sci. (Med.), Scientific Secretary, A.L. Myasnikov Institute of Clinical Cardiology

3rd Cherepkovskaya str., 15a, Moscow 121552

juli001@mail.ruhttps://orcid.org/0000-0001-5215-4894БлиноваН. B.BlinovaN. V.

Блинова Наталия Владимировна, кандидат медицинских наук, старший научный сотрудник отдела гипертонии

ул. 3-я Черепковская, 15-А, Москва 121552

Nataliya V. Blinova, Cand. of Sci. (Med.), Senior Researcher, Department of Hypertension, A.L. Myasnikov Institute of Clinical Cardiology

3rd Cherepkovskaya str., 15a, Moscow 121552

nat-cardio1@yandex.ruФГБУ «Национальный медицинский исследовательский центр кардиологии» им. акад. Е.И. Чазова Минздрава РоссииРоссияE.I. Chazov National Medical Research Center Of CardiologyRussian Federation2022301220221943744Copyright © Кокаева И.О., Жернакова Ю.В., Блинова Н.B., 20222022Кокаева И.О., Жернакова Ю.В., Блинова Н.B.Kokaeva I.O., Zhernakova Y.V., Blinova N.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.syst-hypertension.ru/jour/article/view/645

SARS-CoV-2 – новая коронавирусная инфекция, которая поражает в первую очередь легкие, может также вызывать полиорганное поражение. Артериальная гипертония (АГ), сахарный диабет (СД) и ожирение повышают риск тяжелого течения COVID-19, вплоть до развития фатального цитокинового шторма. Риск развития тяжелой инфекции SARS-CoV-2 у лиц с ожирением и СД связан с исходным системным воспалением и дисфункцией иммунной системы. Кроме того, у этой категории пациентов чаще наблюдается постковидный синдром и ухудшается течение хронических заболеваний. Поражение эндотелия – прямое (инфицирование вирусом SARS-CoV-2) и косвенное (системное воспаление) – может играть решающую роль в развитии осложнений COVID-19. Ангиотензин-превращающий фермент 2 (АПФ-2), экспрессируемый в эндотелии человека, играет фундаментальную роль в новой коронавирусной инфекции. SARS-CoV-2 использует его в качестве рецептора для проникновения внутрь клетки, что приводит к снижению биодоступности АПФ-2 на поверхности эндотелиоцитов. Попадая внутрь, вирус вызывает его апоптоз, приводя к развитию провоспалительного и прокоагулянтного состояния и, как следствие, повреждению сосуда.Препараты, включая ингибиторы АПФ, сартаны, бета-блокаторы и статины, широко назначаются больным с СД, АГ и ИБС – группам, подверженным наибольшему риску при COVID-19, их влияние на эндотелий хорошо известно. Новые классы сахароснижающих препаратов, в частности агонисты рецепторов глюкагоноподобного пептида 1 (ГПП-1) продемонстрировали возможность влиять на системное воспаление и улучшать прогноз у больных СД  и ССЗ. Кроме того, они оказывают позитивное влияние на уровень АД, метаболический профиль. Доказанное снижение веса на фоне применения ГПП-1 может быть дополнительным фактором, определяющим выбор данного класса препаратов. Эти эффекты могут быть использован у больных COVID-19 с высоким риском тяжелого течения, а также у лиц с ожирением в постковидном периоде.

SARS-CoV-2, a novel coronavirus infection that primarily affects the lungs, can induce multi-organ involvement. Arterial hypertension (AH), diabetes mellitus (DM), and obesity increase the risk of severe COVID-19, up to and including the development of a fatal cytokine storm. The risk of severe SARS-CoV-2 infection in persons with obesity and DM is associated with baseline systemic inflammation and immune system dysfunction. In addition, this category of patients is more likely to have post-COVID-19 syndrome and worsen the course of chronic diseases. Endothelial damage – direct (SARS-CoV-2 infection) and indirect (systemic inflammation) may play a crucial role in the development of COVID-19 complications. Angiotensin-converting enzyme 2 (ACE-2) expressed in human endothelium plays a fundamental role in the new coronavirus infection. SARS-CoV-2 uses it as a receptor to enter the cell, which leads to a decrease in the bioavailability of ACE-2 on the endotheliocytes surface. Once inside, the virus induces its apoptosis, leading to the development of a proinflammatory and procoagulant state and, as a result, vascular damage. Drugs including ACE inhibitors, ARB, beta-blockers, and statins are widely prescribed to patients with DM, AH, and CHD, the groups most at risk for COVID-19, and their effects on the endothelium are well known. New classes of hypoglycemic drugs, particularly glucagon-like peptide 1 (GLP-1) receptor agonists, have demonstrated the ability to affect systemic inflammation and improve prognosis in DM and CHD patients. In addition, they have a positive effect on BP and metabolic profile. The proven reduction in weight on the background of the use of GLP-1 may be an additional factor in determining the choice of this class of drugs. These effects can be used in COVID-19 patients with a high risk of severe course, as well as in persons with obesity in the post-COVID-19 condition.

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