pulmoПульмонологияPULMONOLOGIYA0869-01892541-9617Scientific and Practical Journal “PULMONOLOGIYA” LLC10.18093/0869-0189-2023-33-6-760-771pulmo-4332Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL STUDIESПостковидный синдром и патология капиллярного ложа по данным видеокапилляроскопииPost-COVID syndrome and capillary bed abnormalities detected by videocapillaroscopyhttps://orcid.org/0000-0003-3353-0537НгуенХ.К.NguyenH. C.

Нгуен Хоанг Кыонг – аспирант кафедры госпитальной терапии педиатрического факультета.

117997, Москва, ул. Островитянова, 1; тел.: (967) 203-42-77

Hoang Cuong Nguyen - Postgraduate student, Department of Hospital Therapy, Pediatric Faculty.

Ul. Ostrovityanova 1, Moscow, 117997; tel.: (967) 203-42-77

drcuong@mail.ruhttps://orcid.org/0000-0002-5070-5450ЧучалинА. Г.ChuchalinA. G.

Чучалин Александр Григорьевич – доктор медицинских наук, профессор, академик Российской академии наук, заведующий кафедрой госпитальной терапии педиатрического факультета.

117997, Москва, ул. Островитянова, 1; тел.: (499) 780-08-50

Alexander G. Chuchalin - Doctor of Medicine, Professor, Academician of Russian Academy of Sciences, Head of Department of Hospital Internal Medicine, Pediatric Faculty.

Ul. Ostrovityanova 1, Moscow, 117997; tel.: (499) 780-08-50

pulmomoskva@mail.ruФедеральное государственное автономное образовательное учреждение высшего образования «Российский национальный исследовательский медицинский университет имени Н.И. Пирогова» Министерства здравоохранения Российской ФедерацииРоссияFederal State Autonomous Educational Institution of Higher Education “N.I. Pirogov Russian National Research Medical University” of the Ministry of Health of the Russian FederationRussian Federation202312122023336760771Copyright © Нгуен Х.C., Чучалин А.Г., 20232023Нгуен Х., Чучалин А.Г.Nguyen H.C., Chuchalin A.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.pulmonology.ru/pulm/article/view/4332

Постковидный синдром (ПКС) является актуальной проблемой клинической практики. Одышка – наиболее распространенный среди неврологических и сердечно-сосудистых симптомов, которые указывают на низкую толерантность к физической нагрузке (ТФН) и снижение качества жизни пациентов с ПКС.

Целью исследования явилось изучение патогенеза одышки и факторов микрососудистого повреждения, выявленного с помощью видеокапилляроскопии (ВКС), для лучшего понимания их связи с общей клинической картиной у пациентов с ПКС.

Материалы и методы

Материалы и методы. В исследование включены пациенты с ПКС (n = 60), страдающие одышкой, степень которой оценивалась по результатам 6-минутного шагового теста (6-МШТ). Пациенты были распределены на 2 группы: 1-я – больные, у которых выявлена десатурация; 2-я – лица без нарушения сатурации. Патология капиллярного ложа диагностировалась с помощью ВКС.

Результаты

Результаты. При выполнении 6-МШТ пациенты с ПКС проходили в среднем 79,5 % прогнозируемого расстояния. У них также отмечалось снижение показателей пульсоксиметрии. Значительные различия наблюдались у пациентов с десатурацией и без таковой, особенно в отношении пройденной дистанции при выполнении 6-МШТ, показателей пульсоксиметрии и одышки до и после 6-МШТ. У пациентов с десатурацией отмечены более высокие значения соотношения показателей десатурации и дистанции, пройденной при выполнении 6-МШТ (desaturation-distance ratio – DDR), индекса O2-GAP и уровня сердечных усилий (СУ), а также значительное снижение процента перфузируемых капилляров (ППК), средней плотности капилляров (ПК) и заметное повышение доли извилистых и разветвленных капилляров. Выявлена прямая корреляция между ППК и диффузионной способностью легких по монооксиду углерода (DLCO) и коэффициентом переноса монооксида углерода (DLCO / Va), дистанцией, пройденной при выполнении 6-МШТ, и процентом прогнозируемой дистанции, а также обратная корреляция между ППК и СУ. Показана прямая корреляция с долей (%) капиллярного восстановления, пройденной дистанции при выполнении 6-МШТ и прогнозируемой дистанции, а также обратная корреляция – с показателем DDR. Аналогичным образом показана прямая корреляция показателей средней ПК и DLCO / Va, тогда как доля (%) извилистых капилляров обратно коррелировала с DLCO, а доля (%) разветвленных капилляров – с DLCO / Va.

Заключение

Заключение. Продемонстрирован многофакторный характер механизмов возникновения одышки у пациентов с ПКС, при этом отмечена важная роль васкулопатии. Непрерывный мониторинг пульсоксиметрии, частоты сердечных сокращений и ВКС являются эффективными методами изучения и оценки состояния у пациентов с ПКС и одышкой.

Post-COVID syndrome (PCS) is a pressing problem in clinical practice. Dyspnea, along with neurologic and cardiovascular symptoms, is the most common symptom indicating low exercise capacity (EC) that reduces quality of life. The aim of this study was to investigate shortness of breath and the capillary bed abnormalities detected video capillaroscopy (VCS) in patients with PCS.

Methods

Methods. The study included patients with PCS (n = 60) suffering from shortness of breath. Dyspnea was assessed using the 6-minute walk test (6-MWT). The capillary bed abnormality was diagnosed using VCS.

Results

Results. Patients with ACL walked an average of 79.5% of the predicted distance in the 6-MWT. They also had a decrease in pulse oximetry readings. The patients were divided into 2 groups: 1st – patients with desaturation, 2nd – patients without desaturation. Significant differences were observed between patients with and without desaturation, especially in the 6-MWT distance, pulse oximetry, and dyspnea before and after the 6-MWT. Patients with desaturation had a higher desaturation-to-distance ratio, a higher O2-GAP index, and higher cardiac effort levels, as well as a significant decrease in the proportion of perfused capillaries (PPC), mean capillary density, and a marked increase in the proportion of tortuous and branched capillaries. There was a direct correlation between PPC and diffusing lung capacity for carbon monoxide (DLCO), and carbon monoxide transfer coefficient (DLCO/Va), distance traveled during the 6-MWT and percentage (%) of predicted distance, inverse correlation between PPC and cardiac effort. There was a direct correlation between the percentage (%) of capillary recovery and 6-MWT distance and the percentage (%) of predicted distance, as well as an inverse correlation with the ratio of desaturation indicators and walking distance. Similarly, there was a direct correlation between mean capillary density and DLCO/Va, while the proportion (%) of tortuous capillaries was inversely correlated with DLCO, and the proportion (%) of branched capillaries was inversely correlated with DLCO/Va.

Conclusion

Conclusion. The multifactorial nature of the mechanisms of dyspnea in patients with PCS was demonstrated, with the important role of vasculopathy. Continuous monitoring of pulse oximetry, heart rate and VCS are effective methods to screen and assess the condition of patients with PCS and dyspnea.

COVID-19постковидный синдромваскулопатияодышка6-минутный шаговый тествидеокапилляроскопияCOVID-19post-COVID syndromevasculopathydyspnea6-minute walk testvideocapillaroscopyАвторы заявляют об отсутствии внешнего финансирования при проведении исследования и подготовке публикации. Авторы выражают благодарность ординаторам кафедры госпитальной терапии педиатрического факультета Федерального государственного автономного образовательного учреждения высшего образования «Российский национальный исследовательский медицинский университет имени Н.И. Пирогова» Министерства здравоохранения Российской Федерации за помощь в вычислении плотности капиллярной сети и подготовке списка литературыThe authors declare that they did not receive any external funding for the study and preparation of the publication. 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The authors declare that there are no conflicts of interest present.