Chuchalin A G
Pirogov Russian National Research Medical University.
Ter Arkh. 2022 Dec 26;94(11):1333-1339. doi: 10.26442/00403660.2022.11.201943.
The viral infectious disease pandemic caused by SARS-CoV-2 has affected over 500 million people and killed over 6 million. This is the official data provided by the WHO as of the end of May 2022. Among people who have recovered from COVID-19, post-COVID syndrome is quite common. Scattered epidemiological studies on post-COVID syndrome, however, indicate its high relevance. One of the manifestations of post-COVID syndrome is the development of pulmonary fibrosis (PF). This article is devoted to the analysis of literature data on epidemiology, immunomorphology, as well as X-ray morphological and functional characteristics of PF in patients with post-COVID syndrome. Attention is drawn to the various phenotypes of the post-COVID syndrome and the incidence of PF, which, as clinical practice shows, is most common in people who have had severe COVID-19. This article discusses in detail the molecular biological and immunological mechanisms of PF development. The fibrotic process of the lung parenchyma is not an early manifestation of the disease; as a rule, radiomorphological signs of this pathological process develop after four weeks from the onset of acute manifestations of a viral infection. The characteristic signs of PF include those that indicate the process of remodulation of the lung tissue: volumetric decrease in the lungs, "cellular" degeneration of the lung parenchyma, bronchiectasis and traction bronchiolectasis. The process of remodulating the lung tissue, in the process of fibrosis, is accompanied by a violation of the lung function; a particularly sensitive test of functional disorders is a decrease in the diffusion capacity of the lung tissue. Therefore, in the process of monitoring patients with post-COVID syndrome, a dynamic study of the ventilation function of the lungs is recommended. The main clinical manifestation of PF is dyspnea that occurs with minimal exertion. Shortness of breath also reflects another important aspect of fibrous remodulation of the lung parenchyma - oxygen dissociation is disturbed, which reflects a violation of the gas exchange function of the lungs. There are no generally accepted treatments for PF in post-COVID syndrome. The literature considers such approaches as the possibility of prescribing antifibrotic therapy, hyaluronidase, and medical gases: thermal helium, nitric oxide, and atomic hydrogen. The article draws attention to the unresolved issues of post-covid PF in people who have had COVID-19.
由严重急性呼吸综合征冠状病毒2（SARS-CoV-2）引起的病毒性传染病大流行已影响超过5亿人，导致超过600万人死亡。这是世界卫生组织截至2022年5月底提供的官方数据。在从新冠病毒感染中康复的人群中，新冠后综合征相当常见。然而，关于新冠后综合征的零星流行病学研究表明其具有高度相关性。新冠后综合征的表现之一是肺纤维化（PF）的发展。本文致力于分析关于新冠后综合征患者PF的流行病学、免疫形态学以及X线形态学和功能特征的文献数据。文中关注了新冠后综合征的各种表型以及PF的发病率，正如临床实践所示，PF在患有重症新冠的人群中最为常见。本文详细讨论了PF发展的分子生物学和免疫学机制。肺实质的纤维化过程并非该疾病的早期表现；通常，这种病理过程的放射形态学征象在病毒感染急性表现发作四周后才会出现。PF的特征性征象包括那些表明肺组织重塑过程的征象：肺容积减小、肺实质的“细胞性”变性、支气管扩张和牵拉性细支气管扩张。在纤维化过程中，肺组织的重塑过程伴随着肺功能的损害；对功能障碍特别敏感的检测是肺组织弥散能力的下降。因此，在对新冠后综合征患者进行监测的过程中，建议对肺通气功能进行动态研究。PF的主要临床表现是轻微活动时出现的呼吸困难。呼吸急促还反映了肺实质纤维重塑的另一个重要方面——氧解离受到干扰，这反映了肺气体交换功能的损害。对于新冠后综合征中的PF，目前尚无普遍接受的治疗方法。文献中考虑了诸如开具抗纤维化治疗、透明质酸酶以及医用气体（热氦气、一氧化氮和原子氢）等方法。本文提请关注新冠后PF在感染过新冠的人群中尚未解决的问题。
