Клинико-морфологические параллели повреждения легких и почек при COVID-19

В статье рассмотрены имеющиеся литературные данные об особенностях вируса SARS-CoV-2 и сходствах его с пред­шественниками, о механизмах заражения в связи со строением и эпидемиологией возбудителя. Сучётом этих данных описан патогенез новой коронавирусной инфекции COVID-19, на основании чего авторами сделано предположение о вероятных внелёгочных клетках-мишенях и органах-мишенях в зависимости от степени экспрессии ими белка- переносчика для вируса - АПФ-2. Описаны классическая клиническая картина заболевания, возможные осложнения течения и зафиксированные в доступных источниках экстрапульмональные проявления инфекции, в частности, кар­диальные и иммунологические, а также почечные. Авторами прослежена и описана эволюция знаний о вовлечении почек в патологический процесс при COVID-19: на основании данных многочисленных исследований рассмотрено место острого почечного повреждения, коагулопатии, а также системного воспалительного ответа в спектре проявле­ний коронавирусной инфекции относительно почеку пациентов с COVID-19, в том числе, получающих заместительную почечную терапию в форме гемодиализа. В статье выстроены клинико-морфологические ассоциации между пораже­нием лёгких и почек в ходе инфекции COVID-19. Представлены новые данные о патоморфологических проявлениях COVID-19 в лёгких, в том числе собственные данные аутопсий пациентов, выделены и описаны специфические при­знаки воздействия вируса на альвеолоциты, его цитопатический эффект. Главное внимание в статье отведено по­чечным проявлениям инфекции: авторами приведены новые результаты собственных наблюдений, полученные при аутопсии пациентов с COVID-19: подробно описаны морфологические изменения в структурах почек, доказывающие, что почка человека является специфической мишенью для инфекции SARS-CoV-2, а также может служить вирусным резервуаром возбудителя, играя роль в его последующей персистенции.

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