Роль дезинтоксикационной и антиоксидантной терапии в лечении COVID-19: теория и практика


DOI: https://dx.doi.org/10.18565/epidem.2020.2.62-69

Хавкина Д.А., Руженцова Т.А., Чухляев П.В., Гарбузов А.А., Шушакова Е.К.

1) ФБУН «Центральный НИИ эпидемиологии» Роспотребнадзора, Москва, Россия; 2) ГБУ «Станция скорой и неотложной медицинской помощи им. А.С.Пучкова» Департамента здравоохранения города Москвы, Москва, Россия
В литературных источниках, содержащих сведения о течении, диагностике и терапии COVID-19, не упоминается о дезинтоксикационной и/или антиоксидантной терапии. На основе собственного клинического опыта дополнены данные о патогенезе COVID-19, обосновывающие необходимость применения дезинтоксикантов, сорбентов и антиоксидантов для улучшения течения, прогноза и исхода заболевания. Разработанная модель патогенеза COVID-19 обоснована патофизиологически, позитивное влияние предложенной патогенетической терапии продемонстрировано клиническими примерами.
Ключевые слова: COVID-19, антиоксиданты, витамины, зостерин, зостерин-ультра, коронавирусная инфекция, пневмония, токсикология, энтеросорбенты

Литература


1. WHO. Director-General’s remarks at the media briefing on 2019-nCoV on 11 February 2020. https://www.who.int/dg/speeches/ detail/who-director-general-s-remarks-at-the-media-briefing-on-2019-ncov-on-11-february-2020


2. Tang X., Wu C., Li X., Song Yu-He, Yao X., Wu X. et al. On the origin and continuing evolution of SARS-CoV-2. National Science Review 2020. DOI:10.1093/nsr/nwaa036


3. Centers for Disease Control and Prevention. 2019 Novel coronavirus, Wuhan, China. Information for Healthcare Professionals. https://www.cdc.gov/ coronavirus/2019-nCoV/hcp/index.html


4. WHO. Novel Coronavirus (2019-nCoV) technical guidance. https://www.who.int/emergencies/diseases/novel-corona­virus-2019/ technical-guidance


5. WHO Director-General’s opening remarks at the mission briefing on COVID-19 – 26 February 2020. https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-mission-briefing-on-covid-19–26-fe


6. Russell C.D., Millar J.E., Baillie J.K. Clinical evidence does not support corticosteroid treatment for 2019-nCoV lung injury. Lancet 2020; 395: 473–5. https://xn--aciltp-t9a.com/wp-content/uploads/2020/04/20-03-06-clinical-evidence-does-not-support-corticosteroid-treatment.pdf


7. European Centre for Disease Prevention and Control. Novel coronavirus in China. https://www.ecdc.europa.eu/en/novel-coronavirus-china


8. WHO Disease outbreak news: Novel Coronavirus – Republic of Korea (ex-China). January 21, 2020. https://www.who.int/csr/don/21-january-2020-novel-coronavirus-republic-of-korea-ex-china/en/


9. Centers for Disease Control and Prevention. First travel-related case of 2019 novel coronavirus detected in United States, January 21, 2020. https://www.cdc.gov/media/releases/2020/p0121-novel-coronavirus-travel-case.html


10. Centers for Disease Control and Prevention. Second travel-related case of 2019 novel coronavirus detected in United States, January 24, 2020. https: //www.cdc.gov/media/releases/2020/p0124-second-travel-coronavirus. html


11. Day M. Covid-19: Ibuprofen Should not be Used for Managing Symptoms, Say Doctors and Scientists. BMJ 2020; 368: m1086.


12. Yao X., Ye F., Zhang M., Cui Ch., Huang B., Niu Peihua et al. In Vitro Antiviral Activity and Projection of Optimized Dosing Design of Hydroxychloroquine for the Treatment of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Clin. Infect. Dis. 2020. https://pubmed.ncbi.nlm.nih.gov/32150618/


13. European Centre for Disease Prevention and Control. Geographical distribution of 2019-nCov cases. https://www.ecdc.europa.eu/en/geographical-distribution-2019-ncov-cases


14. Centers for Disease Control and Prevention. 2019 Novel Coronavirus (2019-nCoV) in the US. https://www.cdc.gov/coronavirus/2019-ncov/cases-in-us.html


15. Gao J., Tian Z., Yang X. Breakthrough: Chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies. Biosci Trends 2020; 14: 72. DOI:10.5582/bst.2020.01047


16. Colson P., Rolain J.M., Lagier J.C., Brouqui P, Raoult D. Chloroquine and hydroxychloroquine as available weapons to fight COVID-19. Int. J. Antimicrob. Agents 2020; 55(4): 105932. doi: 10.1016/j.ijantimicag.2020. 105932


17. Gautret Ph., Gautret P., Lagier J.C., Parola P. et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. Int. J. Antimicrob. Agents 2020: 105949. DOI:10.1016/j.ijantimicag.2020.105949


18. Groneberg D.A., Poutanen S.M., Low D.E., Lode H., Welte T., Zabel P. Treatment and vaccines for severe acute respiratory syndrome. Lancet Infect. Dis. 2005; (5): 147–55.


19. Chan J.F., Yao Y., Yeung M.L., Deng W., Bao L., Jia L. et al. Treatment With Lopinavir/Ritonavir or Interferon-β1b Improves Outcome of MERS-CoV Infection in a Nonhuman Primate Model of Common Marmoset. J. Infect. Dis. 2015; 212: 1904. DOI:10.1093/infdis/jiv392


20. WHO. Novel coronavirus. Situation report-2. January 22, 2020. https://www.who.int/docs/default-source/coronaviruse/situation-reports/ 20200122-sitrep-2-2019-ncov.pdf


21. Cao B., Wang Y., Wen D., Liu W., Wang J., Fan G. et al. A Trial of Lopinavir-Ritonavir in Adults Hospitalized with Severe Covid-19. N. Engl. J. Med. 2020; 382(19): 1787–99. doi: 10.1056/NEJMoa2001282


22. Wang Y., Liu Y., Liu L., Liu L., Wang X., Luo N. et al. Clinical outcome of 55 asymptomatic cases at the time of hospital admission infected with SARS-Coronavirus-2 in Shenzhen, China. J. Infect. Dis. 2020. DOI:10.1093/ infdis/jiaa119


23. Pan F., Ye T., Sun P., Gui S., Liang B., Li L. et al. Time Course of Lung Changes On Chest CT During Recovery From 2019 Novel Coronavirus (COVID-19) Pneumonia. Radiology 2020. https://doi.org/10.1148/radiol. 2020200370


24. Shi H., Han X., Jiang N., Cao Y., Alwalid O., Gu J. et al. Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study. Lancet Infect. Dis. 2020. https://doi.org/10.1016/S1473-3099(20) 30086-4


25. Chang D., Lin M., Wei L., Xie L., Zhu G., Dela Cruz C.S. Epidemiologic and Clinical Characteristics of Novel Coronavirus Infections Involving 13 Patients Outside Wuhan, China. JAMA 2020. https://jamanetwork.com/journals/jama/fullarticle/2761043


26. Xu X.W., Wu X.X., Jiang X.G., Xu K.J.., Ying L.J., Maet C.L. al. Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-Cov-2) outside of Wuhan, China: retrospective case series. BMJ 2020; 368: m606. DOI:10.1136/bmj.m606


27. Wu J., Liu J., Zhao X. Liu Ch. Clinical Characteristics of Imported Cases of COVID-19 in Jiangsu Province: A Multicenter Descriptive Study. Clin. Infect. Dis. 2020. DOI: 10.1093/cid/ciaa199


28. Wu C., Chen X., Cai Y., Xia J., Zhou X., Xu S. et al. Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA Intern. Med. 2020. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/29.2763184


29. Zhao W., Zhong Z., Xie X., et al. Relation Between Chest CT Findings and Clinical Conditions of Coronavirus Disease (COVID-19) Pneumonia: A Multicenter Study. AJR Am. J. Roentgenol. 2020. doi.org/10.2214/AJR.20. 22976


30. Ai T., Yang Z., Hou H., Zhan C., Chen C., Lv Wet al. Correlation of Chest CT and RT-PCR Testing in Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases. Radiology 2020. DOI: 10.1148/radiol. 2020200642


31. Bai H.X., Hsieh B., Xiong Z., Halsey K., Bai X., Hsieh B. et al. Performance of Radiologists in Differentiating COVID-19 from Viral Pneumonia on Chest CT. Radiology 2020. doi: 10.1148/radiol.2020200823


32. Xie X., Zhong Z., Zhao W., Zheng Ch., Wang F., Liu J. et al. Chest CT for Typical 2019-nCoV Pneumonia: Relationship to Negative RT-PCR Testing. Radiology 2020; 200343. DOI:10.1148/radiol.2020200343


33. Centers for Disease Control and Prevention. Updated Guidance on Evaluating and Testing Persons for COVID-19. HAN429. https://emergency.cdc.gov/ han/2020/han00429.asp?deliveryName=USCDC_511-DM22015


34. Centers for Disease Control and Prevention. Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens from Persons Under Investigation (PUIs) for Coronavirus Disease 2019 (COVID-19). https://www.cdc.gov/ coronavirus/2019-nCoV/lab/guidelines-clinical-specimens.html


35. Patel A., Jernigan D.B. 2019-nCoV CDC Response Team. Initial Public Health Response and Interim Clinical Guidance for the 2019 Novel Coronavirus Outbreak – United States, December 31, 2019 – February 4, 2020. MMWR Morb. Mortal. Wkly Rep. 2020; 69: 140–6.


36. WHO. Coronavirus disease (COVID-19) technical guidance: Surveillance and case definitions. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/surveillance-and-case-definitions


37. WHO. Novel Coronavirus (2019-nCoV) technical guidance: Patient management. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/patient-management


38. WHO. Home care for patients with suspected novel coronavirus (nCoV) infection presenting with mild symptoms and management of contacts. https://www.who.int/publications-detail/home-care-for-patients-with-suspected-novel-coronavirus-(ncov)-infection-presenting-with-mild-symptoms-and-management-of-contacts


39. Профилактика, диагностика и лечение новой коронавирусной инфекции (Covid-19). Временные методические рекомендации Минздрава России. Версия 6 (28.04.2020). https://static1.rosminzdrav.ru/system/attachments/ attaches/000/050/122/original/28042020_МR_COVID-19_v6.pdf.

[Prevention, diagnosis and treatment of new coronavirus infection (Covid-19). Temporary guidelines, Ministry of Нealth of Russia. Version 6 (28.04.2020)]. https: //static1.rosminzdrav.ru/system/attachments/attaches/ 000/050/122/original/28042020_МR_COVID-19_v6.pdf.


40. Регистр лекарственных средств России. https://www.rlsnet.ru

[Register of medicinal products of Russia]. https://www.rlsnet.ru.


Об авторах / Для корреспонденции


Сведения об авторах:
Хавкина Дарья Александровна – врач-терапевт неотложной помощи взрослому населению ГБУ «Станция скорой и неотложной помощи им. А.С. Пучкова» Департамента здравоохранения города Москвы; статистик отдела клинических исследований ФБУН «Центральный НИИ эпидемиологии» Роспитребнадзора, Москва, Россия; e-mail: havkina@gmail.com; ORCID: http://orcid.org/0000-0001-5919-9841
Руженцова Татьяна Александровна – д.м.н., руководитель отдела клинических исследований, профессор образовательного центра ФБУН «Центральный НИИ эпидемиологии» Роспотребнадзора, Москва, Россия; e-mail: ruzhencova@gmail.com; ORCID: http://orcid.org/0000-0002-6945-2019
Чухляев Павел Владимирович – врач-терапевт неотложной помощи взрослому населению ГБУ «Станция скорой и неотложной помощи им. А.С. Пучкова» Департамента здравоохранения города Москвы; методист ФБУН «Центральный НИИ эпидемиологии» Роспотребнадзора, Москва, Россия; e-mail: pafachka@gmail. com; ORCID: http://orcid.org/0000-0003-1210-1215
Гарбузов Александр Александрович – методист ФБУН «Центральный НИИ эпидемиологии» Роспотребнадзора, Москва, Россия; e-mail: os.vertebra@mail.ru; ORCID: http://orcid.org/0000-0002-3378-8418
Шушакова Екатерина Константиновна – младший научный сотрудник клинического отдела инфекционной патологии ФБУН «Центральный НИИ эпидемиологии» Роспотребнадзора, Москва, Россия; e-mail: ketlu@bk.ru


Бионика Медиа