Диагностические маркеры поражения сердца у пациентов со среднетяжелой формой новой коронавирусной инфекции

Abstract

The results of numerous randomized clinical trials indicate the relationship of a new coronavirus infection (NCI) with the development of acute myocardial injury (AMI). Of great importance in the defeat of the heart belongs to the change in the cytokine and chemokine status, which determines the inflammatory potential. The aim of this work was a comprehensive assessment of clinical and laboratory indicators of the state of the heart in a new coronavirus infection and the determination of immunopathogenetic mechanisms of myocardial damage. 180 patients hospitalized with a diagnosis of «coronavirus infection COVID-19, virus identified (U07.1), moderate form» were examined. Risk factors, levels of cytokines and chemokines (IFN-α, IL-6, IL-17, MIP-1b), markers of cardiac damage/dysfunction (troponin I and FAFA, NTproBNP), and antimyocardial IgG antibodies were assessed. Statistical processing was carried out using the Microsoft Office package (Microsoft Excel), as well as the statistical package STATISTICA 9.0. The Shapiro-Wilk W test was used to check the normality of the distribution. Differences were considered significant at p ≤ 0.05, unreliable at p ≥ 0.05. It has been established that in the acute period, 45% of patients have an increase in troponin I values. They also have significantly higher levels of IL-6, IL-17 and MIP-1b against the background of inhibition of IFN-α production. In the acute period, a third of patients have antimyocardial antibodies, which are detected significantly more often and in higher titers in patients with AMI. The presence of a direct correlation between the level of antimyocardial antibodies and an increase in the amount of CRP, MIP-1b and IL-17 was established. The most significant risk factors for the development of myocardial damage in NCI are the presence of a burdened history of cardiovascular diseases, an increased body mass index, and diabetes mellitus. Thus, high levels of CRP, MIP-1b IL-17, antimyocardial antibodies, with a continuing deficiency without a tendency to restore the level of IFN-α, in the presence of the above risk factors, are diagnostically significant markers of AMI in patients with moderate NCI.