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Изменения маркеров гематологического, биохимического и коагулологического анализов крови при новой коронавирусной инфекции COVID-19
Абдуллаев Р.Ю., Комиссарова О.Г. Изменения маркеров гематологического, биохимического и коагулологического анализов крови при новой коронавирусной инфекции COVID-19. Consilium Medicum. 2020; 22 (11): 51–55. DOI: 10.26442/20751753.2020.11.200369
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Abdullaev R.Yu., Komissarova O.G. Changes in markers of hematological, biochemical and coagulological blood tests with coronavirus COVID-19 infections. Consilium Medicum. 2020; 22 (11): . DOI: 10.26442/20751753.2020.11.200369
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Аннотация
В обзоре приводятся новые литературные данные об особенностях изменений показателей клинического и биохимического анализов крови, а также систем гемостаза и фибринолиза у больных с коронавирусной инфекцией COVID-19. Показано, что лабораторные проявления COVID-19 имеют свои особенности и тесно взаимосвязаны с характером течения инфекции. В клиническом анализе крови наиболее часто встречаются лимфопения и тромбоцитопения. Среди биохимических показателей крови чаще выявляются повышение уровня С-реактивного белка и ферритина, а также снижение уровня альбумина. Следует отметить, что у 1/3 тяжелых больных с инфекцией COVID-19 нарастает активность печеночных ферментов – аланинаминотрансферазы и аспартатаминотрансферазы. Среди показателей систем гемостаза и фибринолиза чаще выявляется повышение концентрации Д-димера в плазме крови. В обзоре также анализируются возможные причины изменений некоторых лабораторных показателей при COVID-19.
Ключевые слова: COVID-19, лимфопения, тромбоцитопения, С-реактивный белок, прокальцитонин, ферритин, Д-димер.
Ключевые слова: COVID-19, лимфопения, тромбоцитопения, С-реактивный белок, прокальцитонин, ферритин, Д-димер.
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This review provides new literature data on the features of changes in the indicators of clinical and biochemical analysis of blood, as well as hemostatic and fibrinolysis systems in patients with coronavirus infection COVID-19. It was shown that laboratory manifestations of COVID-19 have their own characteristics and are closely interrelated with the nature of the course of infection. In a clinical blood test, lymphopenia and thrombocytopenia are most common. Among the biochemical parameters of blood, an increase in the level of C-reactive protein and ferritin, as well as a decrease in the level of albumin, are more often detected. It should be noted that in 1/3 of severe patients with COVID-19 infection, the activity of liver enzymes, ALT and AST, increases. Among the indicators of hemostasis and fibrinolysis systems, an increase in the concentration of D-dimer in blood plasma is more often detected. The review also analyzes the possible causes of changes in some laboratory parameters with COVID-19.
Key words: COVID-19, lymphopenia, thrombocytopenia, C-reactive protein, procalcitonin, ferritin, D-dimer.
Полный текст
Список литературы
1. Guan WJ, Ni ZY, Hu Y et al. China Medical Treatment Expert Group for COVID-19. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020. DOI: 10.1056/NEJMoa2002032
2. Wang D, Hu B, Hu C et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. J Am Med Assoc 2020. DOI: 10.1001/jama.2020.1585
3. Liu Y, Yang Y, Zhang C et al. Clinical and biochemical indexes from 2019-nCoV infected patients linked to viral loads and lung injury. Sci China Life Sci 2020. DOI: 10.1007/s11427-020-1643-8
4. Huang C, Wang Y, Li X et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395: 497–506.
5. Bhatraju PK, Ghassemieh BJ, Nichols M et al. Covid-19 in critically ill patients in the Seattle Region – Case Series. N Engl J Med 2020. DOI: 10.1056/NEJMoa2004500
6. Zhang JJ, Dong X, Cao YY et al. Clinical characteristics of 140 patients infected by SARS-CoV-2 in Wuhan, China. Allergy 2020. DOI: 10.1111/all.14238
7. Chen N, Zhou M, Dong X et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395: 507–13.
8. Wang XF, Yuan J, Zheng YJ et al. Clinical and epidemiological characteristics of 34 children with 2019 novel coronavirus infection in Shenzhen. Zhonghua Er Ke Za Zhi 2020; 58: E008.
9. Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost 2020. DOI: 10.1111/jth.14768
10. Lippi G, Plebani M, Henry BM. Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: A meta-analysis. Clin Chim Acta 2020; 506: 145–8. DOI: 10.1016/j.cca.2020.03.022
11. Lippi G, Plebani M. Procalcitonin in patients with severe coronavirus disease 2019 (COVID-19):
A meta-analysis. Clin Chimica Acta 2020; 505: 190–1.
12. Chen H, Guo J, Wang C. et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet 2020. DOI: 10.1016/S0140-6736(20)30360-3
13. Herold T, Jurinovic V, Arnreich C et al. Elevated levels of interleukin-6 and CRP predict the need for mechanical ventilation in COVID-19. J Allergy Clin Immunol 2020. DOI: 10.1016/j.jaci.2020.05.008
14. Lippi G, Plebani M. Laboratory abnormalities in patients with COVID-2019 infection. Clin Chem Lab Med 2020. DOI: 10.1515/cclm-2020-0198
15. Tang N, Bai H, Chen X et al. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost 2020. DOI: 10.1111/jth.14817
16. Paranjpe I, Fuster V, Lala A et al. Association of Treatment Dose Anticoagulation with In-Hospital Survival Among Hospitalized Patients with COVID-19. J Am Coll Cardiol 2020. DOI: 10.1016/j.jacc.2020.05.001
17. Mukund K, Mathee K, Subramaniam S. Plasmin cascade mediates thrombolytic events in SARS-CoV-2 infection via complement and platelet-activating systems. bioRxiv 2020. DOI: 10.1101/2020.05.28.120162
18. Lu G, Wang J. Dynamic changes in routine blood parameters of a severe COVID-19 case. Clin Chimica Acta 2020; 508: 98–102.
19. Stochino C, Villa S, Zucchi P et al. Clinical characteristics of COVID-19 and active tuberculosis co-infection in an Italian reference hospital. Eur Respir J 2020. DOI: 10.1183/13993003.01708-2020
20. Lippi G, Sanchis-Gomar LF. Cardiac troponin in COVID-2019. Prog Cardiovasc Dis 2020. DOI: 10.1016/j.pcad.2020.03.001
21. Bojkova D, Wagner J, Shumliakivska M et al. SARS-CoV-2 infects and induces cytotoxic effects in human cardiomyocytes. bioRxiv. DOI: 10.1101/2020.06.01.127605
22. Zippi M, Fiorino S, Occhigrossi G, Hong W. Hypertransaminasemia in the course of infection with SARS-CoV-2: incidence and pathogenetic hypothesis. World J Clin Cases 2020; 8: 1385–90.
23. Chai X, Hu L, Zhang Y et al. Specific ACE2 expression in cholangiocytes may cause liver damage after 2019-nCoV infection. bioRxiv 2020. DOI: 10.1101/2020.02.03.931766
24. Lippi G, Favaloro EJ. D-dimer is associated with severity of coronavirus disease 2019: a pooled analysis. Thromb Haemost 2020; 120 (5). DOI: 10.1055/s-0040-1709650
25. He L, Mae MA, Sun Y et al. Pericyte-specific vascular expression of SARS-CoV-2 receptor ACE2 – implications for microvascular inflammation and hypercoagulopathy in COVID-19 patients. bioRxiv 2020. DOI: 10.1101/2020.05.11.088500
26. Кубанов А.А., Дерябин Д.Г. Новый взгляд на патогенез COVID-19: заболевание является генерализованным вирусным васкулитом, а возникающее при этом поражение легочной ткани – вариантом ангиогенного отека легкого. Вестник РАМН. 2020; 75 (2). DOI: 10.15690/vramn1347
[Kubanov A.A, Deryabin D. A new look at the COVID-19 pathogenesis: the disease is a generalized viral vasculitis, and the lung tissue damage is a variant of angiogenic pulmonary edema. Annals of the Russian Academy of medical sciences. 2020; 75 (2). DOI: 10.15690/vramn1347 (in Russian).]
27. Liu W, Li H. COVID-19: Attacks the 1-Beta Chain of Hemoglobin and Captures the Porphyrin to Inhibit Human Heme Metabolism. ChemRxiv 2020. DOI: 10.26434/chemrxiv.11938173.v6
28. Lippi G, Mattiuzzi C. Hemoglobin value may be decreased in patients with severe coronavirus disease 2019. Hematol Transfus Cell Ther 2020. DOI: 10.1016/j.htct.2020.03.001
2. Wang D, Hu B, Hu C et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. J Am Med Assoc 2020. DOI: 10.1001/jama.2020.1585
3. Liu Y, Yang Y, Zhang C et al. Clinical and biochemical indexes from 2019-nCoV infected patients linked to viral loads and lung injury. Sci China Life Sci 2020. DOI: 10.1007/s11427-020-1643-8
4. Huang C, Wang Y, Li X et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395: 497–506.
5. Bhatraju PK, Ghassemieh BJ, Nichols M et al. Covid-19 in critically ill patients in the Seattle Region – Case Series. N Engl J Med 2020. DOI: 10.1056/NEJMoa2004500
6. Zhang JJ, Dong X, Cao YY et al. Clinical characteristics of 140 patients infected by SARS-CoV-2 in Wuhan, China. Allergy 2020. DOI: 10.1111/all.14238
7. Chen N, Zhou M, Dong X et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395: 507–13.
8. Wang XF, Yuan J, Zheng YJ et al. Clinical and epidemiological characteristics of 34 children with 2019 novel coronavirus infection in Shenzhen. Zhonghua Er Ke Za Zhi 2020; 58: E008.
9. Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost 2020. DOI: 10.1111/jth.14768
10. Lippi G, Plebani M, Henry BM. Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: A meta-analysis. Clin Chim Acta 2020; 506: 145–8. DOI: 10.1016/j.cca.2020.03.022
11. Lippi G, Plebani M. Procalcitonin in patients with severe coronavirus disease 2019 (COVID-19):
A meta-analysis. Clin Chimica Acta 2020; 505: 190–1.
12. Chen H, Guo J, Wang C. et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet 2020. DOI: 10.1016/S0140-6736(20)30360-3
13. Herold T, Jurinovic V, Arnreich C et al. Elevated levels of interleukin-6 and CRP predict the need for mechanical ventilation in COVID-19. J Allergy Clin Immunol 2020. DOI: 10.1016/j.jaci.2020.05.008
14. Lippi G, Plebani M. Laboratory abnormalities in patients with COVID-2019 infection. Clin Chem Lab Med 2020. DOI: 10.1515/cclm-2020-0198
15. Tang N, Bai H, Chen X et al. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost 2020. DOI: 10.1111/jth.14817
16. Paranjpe I, Fuster V, Lala A et al. Association of Treatment Dose Anticoagulation with In-Hospital Survival Among Hospitalized Patients with COVID-19. J Am Coll Cardiol 2020. DOI: 10.1016/j.jacc.2020.05.001
17. Mukund K, Mathee K, Subramaniam S. Plasmin cascade mediates thrombolytic events in SARS-CoV-2 infection via complement and platelet-activating systems. bioRxiv 2020. DOI: 10.1101/2020.05.28.120162
18. Lu G, Wang J. Dynamic changes in routine blood parameters of a severe COVID-19 case. Clin Chimica Acta 2020; 508: 98–102.
19. Stochino C, Villa S, Zucchi P et al. Clinical characteristics of COVID-19 and active tuberculosis co-infection in an Italian reference hospital. Eur Respir J 2020. DOI: 10.1183/13993003.01708-2020
20. Lippi G, Sanchis-Gomar LF. Cardiac troponin in COVID-2019. Prog Cardiovasc Dis 2020. DOI: 10.1016/j.pcad.2020.03.001
21. Bojkova D, Wagner J, Shumliakivska M et al. SARS-CoV-2 infects and induces cytotoxic effects in human cardiomyocytes. bioRxiv. DOI: 10.1101/2020.06.01.127605
22. Zippi M, Fiorino S, Occhigrossi G, Hong W. Hypertransaminasemia in the course of infection with SARS-CoV-2: incidence and pathogenetic hypothesis. World J Clin Cases 2020; 8: 1385–90.
23. Chai X, Hu L, Zhang Y et al. Specific ACE2 expression in cholangiocytes may cause liver damage after 2019-nCoV infection. bioRxiv 2020. DOI: 10.1101/2020.02.03.931766
24. Lippi G, Favaloro EJ. D-dimer is associated with severity of coronavirus disease 2019: a pooled analysis. Thromb Haemost 2020; 120 (5). DOI: 10.1055/s-0040-1709650
25. He L, Mae MA, Sun Y et al. Pericyte-specific vascular expression of SARS-CoV-2 receptor ACE2 – implications for microvascular inflammation and hypercoagulopathy in COVID-19 patients. bioRxiv 2020. DOI: 10.1101/2020.05.11.088500
26. Кубанов А.А., Дерябин Д.Г. Новый взгляд на патогенез COVID-19: заболевание является генерализованным вирусным васкулитом, а возникающее при этом поражение легочной ткани – вариантом ангиогенного отека легкого. Вестник РАМН. 2020; 75 (2). DOI: 10.15690/vramn1347
[Kubanov A.A, Deryabin D. A new look at the COVID-19 pathogenesis: the disease is a generalized viral vasculitis, and the lung tissue damage is a variant of angiogenic pulmonary edema. Annals of the Russian Academy of medical sciences. 2020; 75 (2). DOI: 10.15690/vramn1347 (in Russian).]
27. Liu W, Li H. COVID-19: Attacks the 1-Beta Chain of Hemoglobin and Captures the Porphyrin to Inhibit Human Heme Metabolism. ChemRxiv 2020. DOI: 10.26434/chemrxiv.11938173.v6
28. Lippi G, Mattiuzzi C. Hemoglobin value may be decreased in patients with severe coronavirus disease 2019. Hematol Transfus Cell Ther 2020. DOI: 10.1016/j.htct.2020.03.001
________________________________________________
1. Guan WJ, Ni ZY, Hu Y et al. China Medical Treatment Expert Group for COVID-19. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020. DOI: 10.1056/NEJMoa2002032
2. Wang D, Hu B, Hu C et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. J Am Med Assoc 2020. DOI: 10.1001/jama.2020.1585
3. Liu Y, Yang Y, Zhang C et al. Clinical and biochemical indexes from 2019-nCoV infected patients linked to viral loads and lung injury. Sci China Life Sci 2020. DOI: 10.1007/s11427-020-1643-8
4. Huang C, Wang Y, Li X et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395: 497–506.
5. Bhatraju PK, Ghassemieh BJ, Nichols M et al. Covid-19 in critically ill patients in the Seattle Region – Case Series. N Engl J Med 2020. DOI: 10.1056/NEJMoa2004500
6. Zhang JJ, Dong X, Cao YY et al. Clinical characteristics of 140 patients infected by SARS-CoV-2 in Wuhan, China. Allergy 2020. DOI: 10.1111/all.14238
7. Chen N, Zhou M, Dong X et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395: 507–13.
8. Wang XF, Yuan J, Zheng YJ et al. Clinical and epidemiological characteristics of 34 children with 2019 novel coronavirus infection in Shenzhen. Zhonghua Er Ke Za Zhi 2020; 58: E008.
9. Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost 2020. DOI: 10.1111/jth.14768
10. Lippi G, Plebani M, Henry BM. Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: A meta-analysis. Clin Chim Acta 2020; 506: 145–8. DOI: 10.1016/j.cca.2020.03.022
11. Lippi G, Plebani M. Procalcitonin in patients with severe coronavirus disease 2019 (COVID-19): A meta-analysis. Clin Chimica Acta 2020; 505: 190–1.
12. Chen H, Guo J, Wang C. et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet 2020. DOI: 10.1016/S0140-6736(20)30360-3
13. Herold T, Jurinovic V, Arnreich C et al. Elevated levels of interleukin-6 and CRP predict the need for mechanical ventilation in COVID-19. J Allergy Clin Immunol 2020. DOI: 10.1016/j.jaci.2020.05.008
14. Lippi G, Plebani M. Laboratory abnormalities in patients with COVID-2019 infection. Clin Chem Lab Med 2020. DOI: 10.1515/cclm-2020-0198
15. Tang N, Bai H, Chen X et al. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost 2020. DOI: 10.1111/jth.14817
16. Paranjpe I, Fuster V, Lala A et al. Association of Treatment Dose Anticoagulation with In-Hospital Survival Among Hospitalized Patients with COVID-19. J Am Coll Cardiol 2020. DOI: 10.1016/j.jacc.2020.05.001
17. Mukund K, Mathee K, Subramaniam S. Plasmin cascade mediates thrombolytic events in SARS-CoV-2 infection via complement and platelet-activating systems. bioRxiv 2020. DOI: 10.1101/2020.05.28.120162
18. Lu G, Wang J. Dynamic changes in routine blood parameters of a severe COVID-19 case. Clin Chimica Acta 2020; 508: 98–102.
19. Stochino C, Villa S, Zucchi P et al. Clinical characteristics of COVID-19 and active tuberculosis co-infection in an Italian reference hospital. Eur Respir J 2020. DOI: 10.1183/13993003.01708-2020
20. Lippi G, Sanchis-Gomar LF. Cardiac troponin in COVID-2019. Prog Cardiovasc Dis 2020. DOI: 10.1016/j.pcad.2020.03.001
21. Bojkova D, Wagner J, Shumliakivska M et al. SARS-CoV-2 infects and induces cytotoxic effects in human cardiomyocytes. bioRxiv. DOI: 10.1101/2020.06.01.127605
22. Zippi M, Fiorino S, Occhigrossi G, Hong W. Hypertransaminasemia in the course of infection with SARS-CoV-2: incidence and pathogenetic hypothesis. World J Clin Cases 2020; 8: 1385–90.
23. Chai X, Hu L, Zhang Y et al. Specific ACE2 expression in cholangiocytes may cause liver damage after 2019-nCoV infection. bioRxiv 2020. DOI: 10.1101/2020.02.03.931766
24. Lippi G, Favaloro EJ. D-dimer is associated with severity of coronavirus disease 2019: a pooled analysis. Thromb Haemost 2020; 120 (5). DOI: 10.1055/s-0040-1709650
25. He L, Mae MA, Sun Y et al. Pericyte-specific vascular expression of SARS-CoV-2 receptor ACE2 – implications for microvascular inflammation and hypercoagulopathy in COVID-19 patients. bioRxiv 2020. DOI: 10.1101/2020.05.11.088500
26. Kubanov A.A, Deryabin D. A new look at the COVID-19 pathogenesis: the disease is a generalized viral vasculitis, and the lung tissue damage is a variant of angiogenic pulmonary edema. Annals of the Russian Academy of medical sciences. 2020; 75 (2). DOI: 10.15690/vramn1347 (in Russian).
27. Liu W, Li H. COVID-19: Attacks the 1-Beta Chain of Hemoglobin and Captures the Porphyrin to Inhibit Human Heme Metabolism. ChemRxiv 2020. DOI: 10.26434/chemrxiv.11938173.v6
28. Lippi G, Mattiuzzi C. Hemoglobin value may be decreased in patients with severe coronavirus disease 2019. Hematol Transfus Cell Ther 2020. DOI: 10.1016/j.htct.2020.03.001
Авторы
Р.Ю. Абдуллаев*1, О.Г. Комиссарова1,2
1 ФГБНУ «Центральный научно-исследовательский институт туберкулеза», Москва, Россия;
2 ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России, Москва, Россия
*rizvan0403@yandex.ru
1 ФГБНУ «Центральный научно-исследовательский институт туберкулеза», Москва, Россия;
2 ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России, Москва, Россия
*rizvan0403@yandex.ru
________________________________________________
Rizvan Yu. Abdullaev*1, Oksana G. Komissarova1,2
1 Central Research Institute of Tuberculosis, Moscow, Russia;
2 Pirogov Russian National Research Medical University, Moscow, Russia
*rizvan0403@yandex.ru
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