urmjУральский медицинский журналUral Medical Journal2949-4389Ural State Medical University10.52420/umj.25.4.49OUWKFSurmj-2289Research ArticleОригинальные статьи | Original articlesOriginal articlesНовая коронавирусная инфекция как фактор риска формирования отдаленных последствий болезни у детейNew Coronavirus Infection as a Risk Factor for The Development of Long-Term Consequences of The Disease in Childrenhttps://orcid.org/0000-0001-7360-5535ОленьковаО. М.OlenkovaO. M.

Ольга Михайловна Оленькова – кандидат медицинских наук, заведующий лабораторией вирусологии

Екатеринбург

Olga M. Olenkova – Candidate of Sciences (Medical), Head of Laboratory of Virology

Ekaterinburg

dcldvir@mail.ruhttps://orcid.org/0000-0002-4462-4179КовтунО. П.KovtunO. P.

Ольга Петровна Ковтун – доктор медицинских наук, профессор, академик Российской академии наук, заслуженный врач РФ, президент

Екатеринбург

Olga P. Kovtun – Doctor of Sciences (Medical), Professor, Academician of the Russian Academy of Sciences, Honored Doctor of the Russian Federation, President

Ekaterinburg

https://orcid.org/0000-0002-3882-4334СабитовА. У.SabitovA. U.

Алебай Усманович Сабитов – доктор медицинских наук, профессор, заслуженный работник высшей школы Российской Федерации, заведующий кафедрой инфекционных болезней и иммунологии, институт профилактической медицины

Екатеринбург

Alebay U. Sabitov – Doctor of Sciences (Medical), Professor, Honored Worker of Higher Education of the Russian Federation, Head of the Department of Infectious Diseases and Immunology, Institute of Preventive Medicine

Ekaterinburg,

Клинико-диагностический центр им. Я. Б. БейкинаРоссияClinical Diagnostic Center named Ya. B. BeikinRussian FederationУральский государственный медицинский университетРоссияUral State Medical UniversityRussian Federation20261808202625449–66Copyright © Оленькова О.М., Ковтун О.П., Сабитов А.У., 20262026Оленькова О.М., Ковтун О.П., Сабитов А.У.Olenkova O.M., Kovtun O.P., Sabitov A.U.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.umjusmu.ru/jour/article/view/2289

COVID-19 у детей вызывает статистически значимые изменения со стороны иммунной и свертывающей систем. Изменения показателей иммунитета и гемостаза сохраняются и в постковидный период, что, в свою очередь, может приводить к формированию неблагоприятных последствий перенесенной инфекции. Цель исследования определение факторов риска формирования отдаленных последствий перенесенной новой коронавирусной инфекции у детей.

Материалы и методы

Материалы и методы . Проведена оценка состояния иммунной системы и системы гемостаза у детей в острый и отдаленный периоды (спустя 4–4,5 месяца после болезни), а также анализ состояния здоровья детей, перенесших COVID-19 ( n = 132). Впервые проведены исследования для анализа состояния иммунитета у болеющих COVID-19 детей и уровня протективности к вакциноуправляемым инфекциям ( n = 60).

Результаты

Результаты . В острый период COVID-19 в иммунограмме детей зарегистрировано увеличение уровня активированных Т-лимфоцитов ( p < 0,001), снижение сывороточных IgM и IgG ( p < 0,050), высокий уровень циркулирующих иммунных комплексов (p < 0,001). Кроме того, у пациентов старше 8-ми лет отмечали наличие лейкопении ( p < 0,050), лимфоцитоза ( p < 0,050), нейтропении ( p < 0,001) и снижение поглотительной активности нейтрофилов ( p < 0,050). В постковидный период сохранялся сниженным уровень иммуноглобулинов М и G, нейтропения, повышенный уровень активированных Т-лимфоцитов, высокий уровень ЦИК.

Оценка показателей коагулограммы в дебюте НКВИ показала наличие сниженной агрегации тромбоцитов ( p < 0,010), тромбинового времени ( p < 0,001), увеличение концентрации фибриногена и D-димера ( p < 0,001), времени лизиса эуглобулинов и высокое содержание растворимых фибрин-мономерных комплексов (РФМК). После перенесенной SARS-CoV-2-инфекции сохранились повышенными значения уровня фибриногена, D-димера, времени лизиса эуглобулинов, РФМК.

Обсуждение

Обсуждение . Острый период НКВИ характеризовался активацией клеточного и фагоцитарного иммунитета, недостаточной гуморальной защитой и высоким уровнем циркулирующих иммунных комплексов. Реакция иммунной системы зависела от возраста детей. В постковидный период у детей 3–17 лет сохранялись отклонения в иммунограмме, указывающие на постинфекционную дисрегуляцию и иммунную недостаточность. Изменения в системе гемостаза в начале НКВИ имели прокоагулянтную направленность и сохранялись в постковидный период. Выявленные изменения в иммунограмме и коагулограмме, а также отклонения в состоянии здоровья детей после COVID-19, позволяют выделить группы риска по развитию неблагоприятных последствий.

Заключение

Заключение . Сохраняющиеся отклонения в иммунной, свертывающей системах и состоянии здоровья детей в постковидный период, низкий уровень защищенности к инфекционным заболеваниям и прививаемым инфекциям являются предрасполагающими факторами развития неблагоприятных последствий и позволяют сформировать группы риска среди детей по их развитию.

COVID-19 in children causes significant changes in the immune and coagulation systems, which persist in the post-COVID period, which can lead to the formation of adverse consequences.

Objective of the study was to determine the risk factors for the development of long-term consequences of a new coronavirus infection in children.

Materials and methods 

Materials and methods . The assessment of the state of the immune and coagulation systems in children in the acute and long-term period, as well as the analysis of the health status of children who have had COVID-19 ( n = 132). Research was conducted to analyze the immune status of children with COVID-19 and their level of protection against vaccinepreventable infections ( n = 60).

Results 

Results . During the acute period of COVID-19, children’s immunograms showed an increase in the level of activated T-lymphocytes ( p < 0.001), a decrease in serum IgM and IgG ( p < 0.050), and a high level of CIC ( p < 0.050). In addition, patients over 8 years of age had leukopenia ( p < 0.05), lymphocytosis ( p < 0.05), neutropenia ( p < 0.001), and decreased neutrophil absorption activity ( p < 0.05). In the post-COVID period, there was a reduced level of immunoglobulins M and G, neutropenia, an increased level of activated T-lymphocytes, and a high level of CIC. Evaluation of coagulogram indicators at the debut of NCI showed the presence of reduced platelet aggregation ( p < 0.010), thrombin time ( p < 0.001), increased concentration of fibrinogen and D-dimer ( p < 0.001), euglobulin lysis time and high content of RFMC. After SARS-CoV-2 infection, increased values of fibrinogen, D-dimer, euglobulin lysis time, RFMC remained.

Discussion 

Discussion . The acute period of NCI was characterized by activation of the cellular and phagocytic links, insufficient levels of humoral protection, high levels of circulating immune complexes, and age-related differences. Changes in hemostasis indicators at the onset of COVID-19 were procoagulant and persisted in the post-COVID period. The identified laboratory changes and health abnormalities provide a basis for identifying risk groups among those who have recovered from the disease.

Conclusion 

Conclusion . Persistent abnormalities in the immune, coagulation, and health systems of children during the post-COVID period, as well as a low level of protection against infectious diseases and vaccine-preventable infections, are predisposing factors for the development of adverse consequences and allow for the formation of risk groups among children based on their development.

 

 

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