Психоневрологические нарушения в структуре постковидного синдрома

Цель исследования. Обобщение и систематизация представлений о патофизиологических механизмах развития астенического синдрома на фоне перенесенного COVID-19.

Материалы и методы. В работе проанализированы научные статьи и монографии, посвященные этиопатогенезу постковидного астенического синдрома (ПКАС). Поиск осуществлялся по ключевым словам «COVID-19», «постковидный синдром», «психоневрологические нарушения», «астенический синдром» с использованием баз данных PubMed, Medline, eLibrary.ru.

Результаты и обсуждение. Систематизированы представления о клинической структуре ПКАС, представлены механизмы проникновения вируса SARS-CoV-2 в нервную систему, освещены современные взгляды в отношении молекулярных механизмов развития неврологической симптоматики у реконвалесцентов COVID-19. Описаны ключевые патогенетические звенья ПКАС, включая иммунные девиации, ассоциированные с нарушением цитокинового баланса, реакции окислительного и нитрозативного стресса с последующей активацией анаэробных метаболических путей в мозговой и мышечной тканях; нейрометаболические изменения, сопровождающиеся дисфункцией серотонинергической, дофаминергической, норадренергической и ГАМК-ергической систем.

Заключение. Анализ данных мировой литературы, а также собственный клинический опыт позволяют заключить, что психоневрологические нарушения, ассоциированные с инфекцией COVID-19, носят многогранный комплексный характер и сопровождаются весьма вариабельной симптоматикой. При этом существующая фрагментарность знаний в отношении патомеханизмов психоневрологических нарушений на фоне COVID-19 диктует настоятельную необходимость продолжения дальнейших исследований в этой области.

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