Karchevskaya N A, Skorobogach I M, Cherniak A V, Migunova E V, Leshchinskaya O V, Kalmanova E N, Bulanov A I, Ostrovskaya E A, Kostin A I, Nikulina V P, Kravchenko N I, Belevskiy A S, Petrikov S S
Sklifosovsky Research Institute for Emergency Medicine.
Pletnev City Clinical Hospital.
Ter Arkh. 2022 Mar 15;94(3):378-388. doi: 10.26442/00403660.2022.03.201399.
To evaluate dynamic changes in the lungs, hemostasis system, immune system in different terms after coronavirus pneumonia.
Ventilation-perfusion single-photon emission computed tomography/computed tomography (CT), functional methods of lung investigation, evaluation of hemostasis system, immune status and specific humoral immune response were performed and evaluated in different terms after coronavirus pneumonia. A total of 71 patients were examined according to this protocol. We examined patients with the lesion volume not less than 50% according to chest CT. All patients were divided into 2 groups depending on the distance from the acute stage of coronavirus pneumonia. Group 1 included patients who were examined early (3060 days after hospital discharge), group 2 included patients who were examined later (61180 days after hospital discharge).
We obtained gradual regression of pathologically-modified tissue from 67.3% during the inpatient phase to 30.9% during the early period and to 19.7% during the late period of examination, according to CT scan of the chest organs. The same tendency was demonstrated by diffusion capacity of the lungs. Perfusion scintigraphy data showed a decrease in perfusion deficit from 26.012.8% during the early period of examination to 19.46.2% during the late period of examination. On the contrary, ventilatory scintigraphy demonstrates the increase of isotope passage time through the alveolar-capillary membrane over time (from 48.231.3 minutes in the early period to 83.637.2 minutes in the late period). An increase in D-dimer was detected in 24% of patients in the early group. The levels of inflammatory markers, indices of immune status, and specific humoral immune response did not differ in the two described groups.
The results demonstrate gradual regression of pathological changes caused by coronavirus infection.
评估新型冠状病毒肺炎后不同时期肺部、止血系统及免疫系统的动态变化。
对新型冠状病毒肺炎后不同时期的患者进行通气灌注单光子发射计算机断层扫描/计算机断层扫描（CT）、肺部功能检查方法、止血系统评估、免疫状态及特异性体液免疫反应的检测与评估。按照该方案共检查了71例患者。根据胸部CT检查，选取病灶体积不少于50%的患者。所有患者根据距新型冠状病毒肺炎急性期的时间分为2组。第1组包括早期检查的患者（出院后30 - 60天），第2组包括晚期检查的患者（出院后61 - 180天）。
根据胸部器官CT扫描，我们发现病理改变组织逐渐消退，住院期为67.3%，早期为30.9%，晚期为19.7%。肺部弥散功能也呈现相同趋势。灌注闪烁扫描数据显示灌注缺损从检查早期的26.0±12.8%降至检查晚期的19.4±6.2%。相反，通气闪烁扫描显示随着时间推移同位素通过肺泡 - 毛细血管膜的时间增加（从早期的48.2±31.3分钟到晚期的83.6±37.2分钟）。早期组24%的患者检测到D - 二聚体升高。上述两组的炎症标志物水平、免疫状态指标及特异性体液免疫反应无差异。
结果表明新型冠状病毒感染所致病理改变逐渐消退。
