Pediatric Hematology/Oncology and ImmunopathologyPediatric Hematology/Oncology and ImmunopathologyВопросы гематологии/онкологии и иммунопатологии в педиатрии1726-17082414-9314Fund Doctors, Innovations, Science for Children55610.24287/1726-1708-2021-20-3-158-168LITERATURE REVIEWОБЗОР ЛИТЕРАТУРЫImmunotherapy in the Treatment of COVID-19Возможности иммунотерапии в лечении COVID-19https://orcid.org/0000-0002-3880-1781MalkovaA. M.МалковаА. М.
Russian Federation

Saint Petersburg

Санкт-Петербург

https://orcid.org/0000-0002-9023-6986StarshinovаA. A.СтаршиноваА. А.
Russian Federation

Anna А. Starshinova, dr. med. sci., Head of the Research Department

2 Akkuratov St., 197341 St. Petersburg 

Старшинова Анна Андреевна, д-р мед. наук, начальник Управления научными исследованиями

197341, Cанкт-Петербург, ул. Аккуратова, 2

starshinova_777@mail.ruKudryavtsevI. V.КудрявцевИ. В.
Russian Federation

Saint Petersburg

Vladivostok

Санкт-Петербург

Владивосток

https://orcid.org/0000-0001-8383-8519DovgalyukI. F.ДовгалюкИ. Ф.
Russian Federation

Saint Petersburg

Санкт-Петербург

https://orcid.org/0000-0002-6273-4304ZinchenkoYu. S.ЗинченкоЮ. С.
Russian Federation

Saint Petersburg

Санкт-Петербург

https://orcid.org/0000-0003-1878-4467KudlayD. A.КудлайД. А.
Russian Federation

Moscow

Москва

Saint Petersburg State UniversityФГБОУ ВО «Санкт-Петербургский государственный университет»Almazov National Medical Research Centre of the Ministry of Healthcare of the Russian FederationФГБУ «Национальный медицинский исследовательский центр им. В.А. Алмазова» Минздрава РоссииInstitute of Experimental MedicineФГБНУ «Институт экспериментальной медицины»Far Eastern Federal UniversityФГАОУ ВО «Дальневосточный федеральный университет»Saint Petersburg Research Institute of Phthisiopulmonology of the Ministry of Healthcare of the Russian FederationФГБУ «Санкт-Петербургский научно-исследовательский институт фтизиопульмонологии» Минздрава РоссииI.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of the Russian Federation (the Sechenov University)ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет)National Research Center – Institute of Immunology Federal Medical-Biological Agency of RussiaФГБУ «Государственный научный центр «Институт иммунологии» ФМБА России081020212031581680810202108102021Copyright ©; 2021, «D. Rogachev NMRCPHOI»Copyright ©; 2021, ФГБУ «НМИЦ ДГОИ им. Дмитрия Рогачева» Минздрава России2021«D. Rogachev NMRCPHOI»ФГБУ «НМИЦ ДГОИ им. Дмитрия Рогачева» Минздрава Россииhttps://creativecommons.org/licenses/by/4.0https://hemoncim.com/jour/article/view/556

The high mortality rate in COVID-19 can be explained by the development of a hyperinflammatory syndrome, characterized by a cytokine storm and extensive thrombus formation. The main direction for preventing the development of hyperinflammatory syndrome and reducing mortality from COVID-19 is immune therapy, however, the data on the efficacy and criteria for prescribing immune drugs is very heterogeneous. The purpose of this review is to analyze the results of clinical trials on the use of various types of immune therapy and possible criteria for its prescription. Analysis of literature data showed that the most effective among the existing variants of immune therapy were monoclonal antibodies to IL-6, the use of donor plasma in the early stages of treatment. Janus kinase inhibitors, intravenous immunoglobulin improved the clinical characteristics of patients, but did not affect the mortality rate. An analysis of possible predictor-markers of the development of a cytokine storm revealed an increase in the number of neutrophils > 11 × 103/ml, a decrease in the number of lymphocytes > 1000 × 103/ml, an increase in the level of IL-6 > 24 pg/ml, LDH > 300 IU/L, D-dimer > 1000 ng/ml, and CRP > 10 mg/dL as the most informative and accessible in clinical practice at the moment.

Достаточно высокую смертность при COVID-19 можно объяснить развитием гипервоспалительного синдрома, характеризующегося цитокиновым штормом и обширным тромбообразованием. Основным направлением по предотвращению развития гипервоспалительного синдрома и по снижению летальности от COVID-19 является иммунная терапия, однако данные об эффективности и критериях назначения иммунных препаратов весьма разнородны. Целью данного обзора является анализ результатов клинических исследований по применению различных видов иммунной терапии при COVID-19 и возможных критериев ее назначения. Анализ литературных данных показал, что из существующих вариантов иммунной терапии наиболее эффективными оказались моноклональные антитела к IL-6, а также использование плазмы доноров на ранних этапах лечения. Ингибиторы янус-киназы, внутривенный иммуноглобулин способствовали улучшению клинического состояния пациентов, однако не влияли на уровень смертности. Авторами статьи был проведен анализ возможных маркеров предикторов развития цитокиновгого шторма. Наибольшую информативность и доступность в клинической практике на данный момент показали повышение количества нейтрофилов > 11 × 103/мл, снижение количества лимфоцитов > 1000 × 103/мл, повышение уровня IL-6 > 24 пг/мл, лактатдегидрогеназы > 300 МЕ/л, Д-димера > 1000 нг/мл и С-реактивного белка > 10 мг/дл.

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