COVID-19 при сопутствующем сахарном диабете: особенности клинического течения, метаболизма, воспалительных и коагуляционных нарушений

Цель исследования — изучить особенности клинического течения COVID-19 при наличии сахарного диабета (СД), а также возможные причины их взаимного отягощения.

Материалы и методы. В исследование включены 64 пациента с COVID-19, в том числе 32 — с СД (основная группа) и 32 — без СД (контрольная группа). Группы формировались по принципу «случай–контроль». В ходе госпитализации отслеживали и сопоставляли динамику клинических, гликемических, коагуляционных показателей, маркеров системного воспаления, дисфункции почек и печени.

Результаты. Среди больных с СД вирусная пневмония протекала тяжелее, о чем говорят увеличение доли лиц с обширным (>50%) поражением легких (в 2,2 раза, р=0,05), повышенная вероятность летального исхода по алгоритму СURB-65 (в 1,3 раза, р=0,043), бóльшая длительность нарушений сатурации кислорода (р=0,0004). При сочетании COVID-19 и СД гипергликемия носит устойчивый характер, без выраженной вариабельности (MAGE — 1,5±0,6 ммоль/л), в большей степени возрастают показатели С-реактивного белка (р=0,028), креатинина (р=0,035) и фибриногена (р=0,013), дольше сохраняются проявления гиперкоагуляции, включая более медленную нормализацию антитромбина III (р=0,012), фибриногена (р=0,037) и D-димера (р=0,035).

Заключение. Наличие сопутствующего СД при COVID-19 ассоциируется с большей тяжестью и распространенностью пневмонии, стойким снижением кислородной обеспеченности, высокой гипергликемией, акселерацией почечных дисфункций, системных воспалительных нарушений и гиперкоагуляции.

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    https://doi.org/10.1172/jci140183.

Belikina D.V., Malysheva E.S., Petrov A.V., Nekrasova T.A., Nekaeva E.S., Lavrova A.E., Zarubina D.G., Atduev K.A., Magomedova D.M., Strongin L.G. COVID-19 in Patients with Diabetes: Clinical Course, Metabolic Status, Inflammation, and Coagulation Disorder. Sovremennye tehnologii v medicine 2020; 12(5): 6, https://doi.org/10.17691/stm2020.12.5.01