microcirculationРегионарное кровообращение и микроциркуляцияRegional blood circulation and microcirculation1682-66552712-9756Academician I.P. Pavlov First St. Petersburg State Medical University10.24884/1682-6655-2021-20-4-87-94microcirculation-1014Research ArticleКРАТКИЕ СООБЩЕНИЯBRIEF SURVEYСравнительный анализ показателей состояния системы гемостаза при тяжелом течении COVID-19Comparative analysis of hemostasis system state indicators in severe COVID-19ТихомироваИ. А.TikhomirovaI. A.

Тихомирова Ирина Александровна – д-р биол. наук, профессор, зав. кафедрой медицины

150000, г. Ярославль, ул. Республиканская, д. 108/1

Tikhomirova Irina A. – Sc. D., Professor, head of Medicine Department

108/1, Respublikanskaya str., Yaroslavl, 150000

tikhom-irina@yandex.ruРябовМ. М.RyabovM. M.

Рябов Михаил Михайлович – канд. мед. наук, ассистент кафедры общей хирургии

150000, г. Ярославль, ул. Революционная, д. 5

Ryabov Mikhail M. – M. D., Ph. D., assistant at the General surgery Department

5, Revolutsionnaya str., Yaroslavl, 150000

mihail_ryabov@mail.ruФедеральное государственное бюджетное образовательное учреждение высшего образования «Ярославский государственный педагогический университет им. К. Д. Ушинского»РоссияYaroslavl State Pedagogical University named after K. D. UshinskyRussian FederationФедеральное государственное бюджетное образовательное учреждение высшего образования «Ярославский государственный медицинский университет» Министерства здравоохранения Российской ФедерацииРоссияYaroslavl State Medical UniversityRussian Federation2021100120222048794Copyright © Тихомирова И.А., Рябов М.М., 20222022Тихомирова И.А., Рябов М.М.Tikhomirova I.A., Ryabov M.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.microcirc.ru/jour/article/view/1014

Введение. Клинический опыт ведения пациентов с новой коронавирусной инфекцией, вызванной вирусом SARS-CoV-2, позволил выявить специфические нарушения гемостаза, на основании чего было введено понятие COVID-ассоциированной коагулопатии. Цель исследования – оценить направленность изменений показателей коагулограммы, параметров свертывания цельной крови и характеристик тромбоцитарного и плазменного гемостаза у пациентов с тяжелым течением COVID-19. Материалы и методы. Для оценки параметров системы гемостаза кровь отбирали венепункцией у 12 пациентов с тяжелой формой COVID-19 и 16 практически здоровых лиц. Процесс свертывания цельной крови исследовали методом низкочастотной пьезотромбоэластографии. С помощью лазерного анализатора агрегации тромбоцитов измеряли число тромбоцитов и показатели спонтанной и АДФ-индуцированной агрегации тромбоцитов. Оценивали фибринолитическую активность плазмы, активность плазминогена, содержание фибриногена, D-димера, протромбиновое время (ПТВ), активированное частичное тромбопластиновое время (АЧТВ), (протромбиновый индекс (ПТИ) и международное нормализованное отношение (МНО). Результаты. У пациентов с тяжелой формой COVID-19 отмечен повышенный уровень фибриногена, 6-кратное увеличение D-димера и удлинение ПТВ. Число тромбоцитов у пациентов было снижено на 51 % (p<0,05), спонтанная агрегация практически не отличалась от нормы. Выявлено почти полное ингибирование реактивности тромбоцитов в отношении АДФ и угнетение XIIa-зависимого фибринолиза, несмотря на повышенную на 19,3 % (p<0,05) активность плазминогена. Выраженная активация тромбоцитарного гемо- стаза, значительная интенсификация полимеризационного этапа формирования сгустка и повышенная интенсивность лизиса и ретракции сгустка зафиксированы при анализе показателей процесса свертывания цельной крови. Заключение. Зафиксированные нами значительный рост уровня D-димера и парадоксальное ингибирование фибринолитической активности плазмы при ее изолированной оценке по тесту XIIа-зависимого фибринолиза (в отличие от повышенной интенсивности лизиса сгустка при оценке свертывания цельной крови) свидетельствуют о комплексном характере патогенетических механизмов коагулопатии при инфицировании SARS-CoV-2 и вовлеченности клеточных компонентов крови и сосудистой стенки в процесс патологического тромбообразования.

Introduction. Clinical experience in managing patients with a new coronavirus infection caused by the SARS-CoV-2 allowed to identify specific hemostasis disorders, and enables to introduce the concept of COVID-associated coagulopathy. The aim of the study was to assess the direction of coagulogram parameter changes, whole blood clotting parameters and characteristics of platelet and plasma hemostasis in patients with severe COVID-19. Materials and methods. The parameters of the hemostasis system were assessed using venous blood of 12 patients with severe COVID-19 and 16 healthy volunteers. The whole blood clotting process was investigated by low-frequency piezothromboelastography. The platelet count and indicators of spontaneous and ADP-induced platelet aggregation were estimated with the help of a laser platelet aggregation analyzer. Fibrinolytic activity of plasma, plasminogen activity, content of fibrinogen, D-dimer, PTT, APTT, PTI and INR were assessed. Results. An increased level of fibrinogen, a 6-fold increased D-dimer level, and increased PTT were found in patients with severe COVID-19. The patient platelets count was reduced by 51 % (p <0.05), spontaneous platelet aggregation remained at nearly normal level. Almost complete inhibition of ADP-induced platelet reactivity and inhibition of XIIa-dependent fibrinolysis was revealed, despite an increased by 19.3 % (p <0.05) plasminogen activity. Parameters of the whole blood coagulation process pointed a pronounced activation of platelet hemostasis, a significant intensification of the polymerization stage of clot formation and an increased intensity of clot lysis and retraction. Conclusion. The significant increase of D-dimer level and paradoxical inhibition of plasma fibrinolytic activity revealed by test of XIIa-dependent fibrinolysis (in contrast to the increased intensity of clot lysis when assessing the coagulation of whole blood) indicate the complex pathogenic mechanisms of coagulopathy caused by SARS-CoV-2 infection, and the involvement of blood cells and the vascular wall in the process of pathological thrombus formation.

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