medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»10.33667/2078-5631-2021-1-26-30medalphabet-1949Research ArticleКОМОРБИДНЫЕ СОСТОЯНИЯCOMORBIDITYИнсульт и COVID-19Stroke and COVID‑19https://orcid.org/0000-0003-1499-247XОстроумоваТ. М.OstroumovaT. M.

Остроумова Татьяна Максимова, к.м.н., ассистент кафедры нервных болезней и нейрохирургии Института клинической медицины им. Н. В. Склифосовского

Москва

Ostroumova Tatiana M.

Moscow

t.ostroumova3@gmail.comhttps://orcid.org/0000-0002-0795-8225ОстроумоваО. Д.OstroumovaO. D.

Остроумова Ольга Дмитриевна, д.м.н., проф., зав. кафедрой терапии и полиморбидной патологии

Москва

Ostroumova Olga D.

Moscow

ostroumova.olga@mail.ruhttps://orcid.org/0000-0002-7294-7274АраблинскийН. А.ArablinskyN. A.

Араблинский Никита Александрович, студент VI курса лечебного факультета

Москва

Arablinsky Nikita A.

Moscow

nekit1868@yandex.ruГоловинаО. В.GolovinaO. V.

Головина Ольга Владимировна к. м.н, доцент кафедры терапии и полиморбидной патологии

Москва

Golovina Olga V.

Moscow

olenka_golovina@list.ruФГАОУ ВО «Первый Московский государственный медицинский университет имени И. М. Сеченова» Минздрава России (Сеченовский университет)РоссияFirst Moscow State Medical University n. a. I. M. SechenovRussian FederationФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава РоссииРоссияRussian Medical Academy for Continuing Professional EducationRussian FederationФГАОУ ВО «Российский национальный исследовательский медицинский университет имени Н. И. Пирогова» Минздрава РоссииРоссияRussian National Research Medical University n. a. N. I. PirogovRussian Federation20210904202101Коморбидные состояния (1)2630Copyright © Остроумова Т.М., Остроумова О.Д., Араблинский Н.А., Головина О.В., 20212021Остроумова Т.М., Остроумова О.Д., Араблинский Н.А., Головина О.В.Ostroumova T.M., Ostroumova O.D., Arablinsky N.A., Golovina O.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.med-alphabet.com/jour/article/view/1949

Частота развития всех острых нарушений мозгового кровообращения при COVID-19 варьирует в пределах 0,2–1,3 %, при этом чаще встречается ишемический инсульт (ИИ) – 1,1 %, доля геморрагического инсульта составляет около 0,2 %. Наличие COVID-19 ассоциировано с увеличением риска ИИ в 3,58 и внутрибольничной смертности – в 5,60 раза. Инфекция COVID-19 увеличивает риск развития разных подтипов инсульта, особенно криптогенного, для которого характерно наиболее тяжелое течение. Патогенез инсульта при COVID-19 сложен и включает ряд патофизиологических механизмов: коагулопатию, тромбоэмболии, васкулиты, прямое нейрональное повреждение. Многие патофизиологические механизмы инсульта COVID-19 еще предстоит идентифицировать, что диктует необходимость проведения дальнейших научных исследований. Для инсультов у пациентов с COVID-19 часто характерны более тяжелое течение, высокая летальность. Возникновение инсульта при COVID-19 сравнительно нередко встречается в более молодых возрастных группах, у лиц без каких-либо традиционных факторов риска инсульта. Из-за коагулопатии, развивающейся при COVID-19, потенциально снижается эффективность реперфузионной терапии (тромболизис и тромбоэкстракция). Все это диктует необходимость раннего начала мероприятий по вторичной профилактике и ранней активной реабилитации, одним из звеньев которой является назначение препаратов, обладающих цитопротективными и нейропротективными свойствами. Выбирая определенный нейропротективный препарат, следует обращать особое внимание на наличие у данного лекарственного средства доказательной базы, подтверждающей его эффективность и безопасность именно при инсультах; не менее важно, чтобы препарат обладал мультимодальным механизмом для воздействия на максимально возможное количество многообразных патофизиологических механизмов развития инсульта у пациентов с COVID-19. Цитиколин представляется перспективным препаратом для пациентов, перенесших инсульт в сочетании с COVID-19, поскольку его эффективность в условиях острой ишемии обусловлена несколькими механизмами действия, кроме того, препарат имеет большую доказательную базу именно при лечении инсульта.

The incidence of all acute cerebrovascular events in COVID-19 patients ranges between 0.2 and 1.3 %, while ischemic stroke (IS) is more common – 1.1 %, the proportion of hemorrhagic stroke is about 0.2 %. The presence of COVID-19 is associated with 3.58 times increased risk of IS and 5.60 times risk of in-hospital mortality. COVID-19 infection increases the risk of different subtypes of IS, especially cryptogenic stroke, which is characterized by the most severe course. The pathogenesis of stroke in COVID-19 is complex and includes a number of pathophysiological mechanisms: coagulopathy, thromboembolism, vasculitis, direct neuronal damage. The main pathophysiological mechanisms in COVID-19 stroke are yet to be established and need further investigation. Strokes in patients with COVID-19 are often characterized by a more severe course and high mortality. The stroke onset in COVID-19 patients is relatively common in younger age groups and in people without any traditional stroke risk factors. Due to the coagulopathy in COVID-19, the effectiveness of reperfusion therapy (thrombolysis and thromboextraction) is potentially reduced. Thus, early initiation of secondary prevention and active rehabilitation, which includes the drugs with cytoprotective and neuroprotective properties, are needed. When choosing a specific neuroprotective drug, special attention should be paid to the drug’s evidence base confirming its efficacy and safety, especially in stroke, it is equally important that the drug has a multimodal mechanism of action to affect the maximum possible diverse pathophysiological mechanisms of stroke development in patients with COVID-19. Citicoline appears to be a promising drug for stroke patients with COVID-19, since its effectiveness in acute ischemia is due to several mechanisms of action, in addition, the drug has a large evidence base in the treatment of stroke.

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