При коронавирусной инфекции COVID-19 у части пациентов, преимущественно требующих вентиляционной поддержки, развивается цитокиновый шторм, который приводит к системному воспалительному ответу и полиорганной недостаточности. Одной из стратегий терапии цитокинового шторма является использование гуманизированных моноклональных антител к рецептору интерлейкина-6 (ИЛ-6), в частности препарата тоцилизумаб. Висследование включен 131 госпитализированный пациент с инфекцией COVID-19, получивший препарат тоцилизумаб в дозе 8 мг/кг через 10 [9; 12] суток после начала заболевания. Пациенты были разделены на 2 группы в зависимости от достижения конечной точки: выписка пациента из стационара (95 пациентов, группа 1) или смерть (36 пациентов, группа 2). Неблагоприятные клинические исходы при использовании препарата тоцилизумаб для лечения инфекции COVID-19 связаны с более старшим возрастом пациентов (57 [48; 62] лет в группе 1 против 63 [52; 69] лет в группе 2 (p<0,011); тяжестью поражения легких (тяжелое поражение по данным компьютерной томографии было у 37 (38,9%) пациентов группы 1 и 28 (77,8%) пациентов группы 2 (р<0,001); большей потребностью в О2 при спонтанном дыхании (7 [5,0; 10,0] л/мин в группе 1 против 12 [9,0; 15,0] л/мин в группе 2 (р<0,001); необходимостью проведения искусственной вентиляции легких (ИВЛ), более высоким уровнем ИЛ-6 (в группе 1 уровень ИЛ-6 составил 67,4 [36,4; 90,3] пг/мл против 127,0 [81,7; 339,1] пг/мл в группе 2 (р=0,002)). Через 6 суток после введения препарата тоцилизумаб по результатам рутинных лабораторных тестов (уровень лейкоцитов, лимфоцитов, соотношение нейтрофилы/лимфоциты, С-реактивный белок, креатинфосфокиназа, лактатдегидрогеназа) можно прогнозировать исход заболевания. A certain number of COVID-19 patients develops cytokine storm, which leads to the systemic inflammatory response and multiple organ failure. One of the strategies for this cytokine storm management is using of humanized monoclonal antibodies to interleukin-6 (IL-6) receptor, tocilizumab. The study included 131 hospitalized patients with COVID-19 infection, who received tocilizumab (8 mg/kg) 10 [9; 12] days after the onset of disease. Patients were divided into 2 groups, depending on the outcome: discharge from the hospital (95 patients, group 1) or death (36 patients, group 2). Adverse clinical outcomes when using Tocilizumab for the COVID-19 infection are associated with older age of patient (57 [48; 62] years in the group 1 versus 63 [52; 69] years in group 2 (p<0.011). 37 (38.9%) patients in the group 1 had severe lung damage according to computer tomography versus 28 (77.8%) patients in the group 2 (p<0.001). In the 1st group, the need for O2 was lower: the flow during spontaneous breathing was 7 [5.0; 10.0] l/min versus 12 [9.0; 15.0] l/min in the 2nd group (p<0,001); and the need for mechanical ventilation was lower too. Patients in the 1st group had lower level of IL-6 - 67.4 [36.4; 90.3] pg/ml versus 127.0 [81.7; 339.1] pg/ml in the 2nd group (p=0.002). In 6 days after tocilizumab administration, according to the results of routine laboratory tests (leukocyte, lymphocyte count, neutrophil/lymphocyte ratio, C-reactive protein, creatine kinase, lactate dehydrogenase), the outcome of the disease can be predicted.
Objective: to evaluate the dynamics of the markers of oxidative stress in patients with chronic obstructive pulmonary disease (COPD) during the application of atorvastatin. Material and methods. The study included 52 COPD patients with concomitant hyperlipidemia. The main group (n = 30) were given atorvastatin at a dosage of 20 mg per day in addition to the standard COPD treatment. The comparison group (n = 22) only underwent the standard COPD treatment. The patients were monitored for 24 weeks. The levels of superoxide dismutase, catalase and malondialdehyde were evaluated for the assessment of oxidative stress. Results. In the group of the patients taking atorvastatin, the level of superoxide dismutase decreased from 949 [608; 1042] units/ml initially to 406 [319; 478] u/ml after 24 weeks (p = 0.035). The levels of catalase and malondialdehyde did not change significantly both in the experimental and comparison groups. Conclusion. The intake of atorvastatin decreases the level of superoxide dismutase, which may indicate a decrease in the level of oxidative stress in COPD patients.
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