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Клинико-морфологические особенности поражения легких в отдаленные сроки после перенесенного SARS-CоV-2
Клинико-морфологические особенности поражения легких в отдаленные сроки после перенесенного SARS-CоV-2
Баймаканова Г.Е., Самсонова М.В., Черняев А.Л., Конторщиков А.С., Белевский А.С. Клинико-морфологические особенности поражения легких в отдаленные сроки после перенесенного SARS-CоV-2. Терапевтический архив. 2024;96(3):218–227. DOI: 10.26442/00403660.2024.03.202647
© ООО «КОНСИЛИУМ МЕДИКУМ», 2024 г.
2024;96(3):218–227. DOI: 10.26442/00403660.2024.03.202647
© ООО «КОНСИЛИУМ МЕДИКУМ», 2024 г.
________________________________________________
2024;96(3):218–227. DOI: 10.26442/00403660.2024.03.202647
Материалы доступны только для специалистов сферы здравоохранения. Авторизуйтесь или зарегистрируйтесь.
Аннотация
Цель. Изучить клинический и гистологический профиль ткани легких у пациентов с персистирующим поражением легких, стойкими респираторными симптомами и компьютерной томографической (КТ) картиной после перенесенной инфекции SARS-CoV-2.
Материалы и методы. В исследовании приняли участие 15 пациентов (7 женщин и 8 мужчин), средний возраст – 57,7 года. Всем пациентам выполнены лабораторные исследования, КТ органов грудной клетки, эхокардиография, функция внешнего дыхания. Образцы легких и бронхоальвеолярного лаважа получены с помощью фибробронхоскопии, трансбронхиальной щипцовой (2 пациента), криобиопсии легких (11 пациентов), открытая биопсия выполнена у 2 пациентов. В бронхоальвеолярном лаваже определяли клеточный состав, ДНК герпес-вирусов, SARS-CoV-2, Mycobacterium tuberculosis complex, индекс оптической плотности галактоманнана, рост бактериальной и грибковой микрофлоры. SARS-CoV-2 методом полимеразной цепной реакции также определяли в образцах со слизистой носа, зева и в кале.
Результаты. Показано, что у пациентов после перенесенной инфекции SARS-CoV-2 со стойкими респираторными симптомами, функциональными нарушениями и КТ-картиной после перенесенной инфекции SARS-CoV-2 не обнаружено истинного легочного фиброза. Выявленные изменения соответствуют актуальной и/или разрешающейся инфекции и воспалительному процессу.
Заключение. Таким образом, у пациентов после перенесенной инфекции SARS-CoV-2 со стойкими респираторными симптомами, функциональными нарушениями и КТ-картиной после перенесенной инфекции SARS-CoV-2 не обнаружено истинного легочного фиброза. Выявленные изменения соответствуют актуальной и/или разрешающейся инфекции и воспалительному процессу.
Ключевые слова: SARS-CоV-2, интерстициальная пневмония, легочный фиброз
Materials and methods. The study included 15 patients (7 females and 8 males) with a mean age of 57.7 years. All patients underwent laboratory tests, chest computed tomography, echocardiography, and pulmonary function tests. Pulmonary tissue and bronchoalveolar lavage samples were obtained by fibrobronchoscopy, transbronchial forceps (2 patients), and lung cryobiopsy (11 patients); open biopsy was performed in 2 patients. Cellular composition, herpesvirus DNA, SARS-CoV-2, Mycobacterium tuberculosis complex, galactomannan optical density index, and bacterial and fungal microflora growth were determined in bronchoalveolar lavage. SARS-CoV-2 was also identified in samples from the nasal mucosa, throat and feces using a polymerase chain reaction.
Results. The results showed no true pulmonary fibrosis in patients recovered from SARS-CoV-2 infection with persistent respiratory symptoms, functional impairment, and CT findings after SARS-CoV-2 infection. The observed changes comply with the current and/or resolving infection and inflammatory process.
Conclusion. Thus, no true pulmonary fibrosis was found in patients after SARS-CoV-2 infection with persistent respiratory symptoms, functional impairment, and CT findings. The observed changes comply with the current and/or resolving infection and inflammatory process.
Keywords: SARS-CoV-2, interstitial pneumonia, pulmonary fibrosis
Материалы и методы. В исследовании приняли участие 15 пациентов (7 женщин и 8 мужчин), средний возраст – 57,7 года. Всем пациентам выполнены лабораторные исследования, КТ органов грудной клетки, эхокардиография, функция внешнего дыхания. Образцы легких и бронхоальвеолярного лаважа получены с помощью фибробронхоскопии, трансбронхиальной щипцовой (2 пациента), криобиопсии легких (11 пациентов), открытая биопсия выполнена у 2 пациентов. В бронхоальвеолярном лаваже определяли клеточный состав, ДНК герпес-вирусов, SARS-CoV-2, Mycobacterium tuberculosis complex, индекс оптической плотности галактоманнана, рост бактериальной и грибковой микрофлоры. SARS-CoV-2 методом полимеразной цепной реакции также определяли в образцах со слизистой носа, зева и в кале.
Результаты. Показано, что у пациентов после перенесенной инфекции SARS-CoV-2 со стойкими респираторными симптомами, функциональными нарушениями и КТ-картиной после перенесенной инфекции SARS-CoV-2 не обнаружено истинного легочного фиброза. Выявленные изменения соответствуют актуальной и/или разрешающейся инфекции и воспалительному процессу.
Заключение. Таким образом, у пациентов после перенесенной инфекции SARS-CoV-2 со стойкими респираторными симптомами, функциональными нарушениями и КТ-картиной после перенесенной инфекции SARS-CoV-2 не обнаружено истинного легочного фиброза. Выявленные изменения соответствуют актуальной и/или разрешающейся инфекции и воспалительному процессу.
Ключевые слова: SARS-CоV-2, интерстициальная пневмония, легочный фиброз
________________________________________________
Materials and methods. The study included 15 patients (7 females and 8 males) with a mean age of 57.7 years. All patients underwent laboratory tests, chest computed tomography, echocardiography, and pulmonary function tests. Pulmonary tissue and bronchoalveolar lavage samples were obtained by fibrobronchoscopy, transbronchial forceps (2 patients), and lung cryobiopsy (11 patients); open biopsy was performed in 2 patients. Cellular composition, herpesvirus DNA, SARS-CoV-2, Mycobacterium tuberculosis complex, galactomannan optical density index, and bacterial and fungal microflora growth were determined in bronchoalveolar lavage. SARS-CoV-2 was also identified in samples from the nasal mucosa, throat and feces using a polymerase chain reaction.
Results. The results showed no true pulmonary fibrosis in patients recovered from SARS-CoV-2 infection with persistent respiratory symptoms, functional impairment, and CT findings after SARS-CoV-2 infection. The observed changes comply with the current and/or resolving infection and inflammatory process.
Conclusion. Thus, no true pulmonary fibrosis was found in patients after SARS-CoV-2 infection with persistent respiratory symptoms, functional impairment, and CT findings. The observed changes comply with the current and/or resolving infection and inflammatory process.
Keywords: SARS-CoV-2, interstitial pneumonia, pulmonary fibrosis
Полный текст
Список литературы
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23. Ravaglia C, Doglioni C, Chilosi M, et al. Clinical, radiological and pathological findings in patients with persistent lung disease following SARS-CoV-2 infection. Eur Respir J. 2022;60(4):2102411. DOI:10.1183/13993003.02411-2021
24. Aesif SW, Bribriesco AC, Yadav R, et al. Pulmonary Pathology of COVID-19 Following 8 Weeks to 4 Months of Severe Disease: A Report of Three Cases, Including One With Bilateral Lung Transplantation. Am J Clin Pathol. 2021;155(4):506-14. DOI:10.1093/ajcp/aqaa264
25. Konopka KE, Perry W, Huang T, et al. Usual Interstitial Pneumonia is the Most Common Finding in Surgical Lung Biopsies from Patients with Persistent Interstitial Lung Disease Following Infection with SARS-CoV-2. EClinicalMedicine. 2021;42:101209. DOI:10.1016/j.eclinm.2021.101209
26. Swank Z, Senussi Y, Manickas-Hill Z, et al. Persistent Circulating Severe Acute Respiratory Syndrome Coronavirus 2 Spike Is Associated With Post-acute Coronavirus Disease 2019 Sequelae. Clin Infect Dis. 2023;76(3):e487-90. DOI:10.1093/cid/ciac722
27. Proal AD, VanElzakker MB. Long COVID or Post-acute Sequelae of COVID-19 (PASC): An Overview of Biological Factors That May Contribute to Persistent Symptoms. Front Microbiol. 2021;12:698169. DOI:10.3389/fmicb.2021.698169
28. Phetsouphanh C, Darley DR, Wilson DB, et al. Immunological dysfunction persists for 8 months following initial mild-to-moderate SARS-CoV-2 infection. Nat Immunol. 2022;23(2):210-6. DOI:10.1038/s41590-021-01113-x
29. Zubchenko S, Kril I, Nadizhko O, et al. Herpesvirus infections and post-COVID-19 manifestations: a pilot observational study. Rheumatol Int. 2022;42(9):1523-30. DOI:10.1007/s00296-022-05146-9
30. Liu Q, Mak JWY, Su Q, et al. Gut microbiota dynamics in a prospective cohort of patients with post-acute COVID-19 syndrome. Gut. 2022;71(3):544-52.
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31. Yeoh YK, Zuo T, Lui GC, et al. Gut microbiota composition reflects disease severity and dysfunctional immune responses in patients with COVID-19. Gut. 2021;70(4):698-706. DOI:10.1136/gutjnl-2020-323020
32. Wallukat G, Hohberger B, Wenzel K, et al. Functional autoantibodies against G-protein coupled receptors in patients with persistent Long-COVID-19 symptoms. J Transl Autoimmun. 2021;4:100100. DOI:10.1016/j.jtauto.2021.100100
33. Su Y, Yuan D, Chen DG, et al. Multiple early factors anticipate post-acute COVID-19 sequelae. Cell. 2022;185(5):881-95.e20. DOI:10.1016/j.cell.2022.01.014
34. Arthur JM, Forrest JC, Boehme KW, et al. Development of ACE2 autoantibodies after SARS-CoV-2 infection. PLoS One. 2021;16(9):e0257016. DOI:10.1371/journal.pone.0257016
35. Charfeddine S, Ibn Hadj Amor H, Jdidi J, et al. Long COVID-19 Syndrome: Is It Related to Microcirculation and Endothelial Dysfunction? Insights From TUN-EndCOV Study. Front Cardiovasc Med. 2021;8:745758. DOI:10.3389/fcvm.2021.745758
36. Pretorius E, Venter C, Laubscher GJ, et al. Prevalence of symptoms, comorbidities, fibrin amyloid microclots and platelet pathology in individuals with Long COVID/Post-Acute Sequelae of COVID-19 (PASC). Cardiovasc Diabetol. 2022;21(1):148. DOI:10.1186/s12933-022-01579-5
37. Spudich S, Nath A. Nervous system consequences of COVID-19. Science. 2022;375(6578):267-9. DOI:10.1126/science.abm2052
38. Ehab A, Reissfelder F, Laufer J, et al. Transbronchial lung cryobiopsy performed in acute COVID-19 pneumonia: first report. Adv Respir Med. 2021;89(1):72-4. DOI:10.5603/ARM.a2021.0032
39. De Gopegui Miguelena PR, Chamarro MP, Vega LMC. Afectación endotelial por Covid-19 en criobiopsia pulmonar. Archivos de Bronconeumología. 2020;57:65. DOI:10.1016/j.arbres.2020.06.010
40. Doglioni C, Ravaglia C, Rossi G, et al. Acute Lung injury evolution in Covid-19. MedRxiv. 2020. DOI:10.1101/2020.08.09.20170910
41. Barisione E, Grillo F, Ball L, et al. Fibrotic progression and radiologic correlation in matched lung samples from COVID-19 post-mortems. Virchows Arch. 2021;478(3):471-85. DOI:10.1007/s00428-020-02934-1
42. Su Y, Yuan D, Chen DG, et al. Multiple early factors anticipate post-acute COVID-19 sequelae. Cell. 2022;185(5):881-95.e20. DOI:10.1016/j.cell.2022.01.014
43. Bastard P, Gervais A, Le Voyer T, et al. Autoantibodies neutralizing type I IFNs are present in ~4% of uninfected individuals over 70 years old and account for ~20% of COVID-19 deaths. Sci Immunol. 2021;6(62):eabl4340. DOI:10.1126/sciimmunol.abl4340
44. Wang C, Wang Z, Wang G, et al. COVID-19 in early 2021: current status and looking forward. Signal Transduct Target Ther. 2021;6(1):114. DOI:10.1038/s41392-021-00527-1
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46. Chang S, Pierson E, Koh PW, et al. Mobility network models of COVID-19 explain inequities and inform reopening. Nature. 2021;589(7840):82-7. DOI:10.1038/s41586-020-2923-3
47. Parasa S, Desai M, Thoguluva Chandrasekar V, et al. Prevalence of Gastrointestinal Symptoms and Fecal Viral Shedding in Patients With Coronavirus Disease 2019: A Systematic Review and Meta-analysis. JAMA Netw Open. 2020;3(6):e2011335. DOI:10.1001/jamanetworkopen.2020.11335
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49. Sugimoto MA, Sousa LP, Pinho V, et al. Resolution of Inflammation: What Controls Its Onset? Front Immunol. 2016;7:160. DOI:10.3389/fimmu.2016.00160
50. Bozza FA, Salluh JI, Japiassu AM, et al. Cytokine profiles as markers of disease severity in sepsis: a multiplex analysis. Crit Care. 2007;11(2):R49. DOI:10.1186/cc5783
51. Pretorius L, Kell DB, Pretorius E. Iron Dysregulation and Dormant Microbes as Causative Agents for Impaired Blood Rheology and Pathological Clotting in Alzheimer's Type Dementia. Front Neurosci. 2018;12:851. DOI:10.3389/fnins.2018.00851
52. Fitridge R, Thompson M, eds. Mechanisms of Vascular Disease: A Reference Book for Vascular Specialists. Adelaide (AU): University of Adelaide Press, 2011.
53. Hamers L, Kox M, Pickkers P. Sepsis-induced immunoparalysis: mechanisms, markers, and treatment options. Minerva Anestesiol. 2015;81(4):426-39.
54. Walton AH, Muenzer JT, Rasche D, et al. Reactivation of multiple viruses in patients with sepsis. PLoS One. 2014;9(2):e98819. DOI:10.1371/journal.pone.0098819
55. Xu K, Cai H, Shen Y, et al. Management of COVID-19: the Zhejiang experience. Zhejiang Da Xue Xue Bao Yi Xue Ban. 2020;49(2):147-57. DOI:10.3785/j.issn.1008-9292.2020.02.02
56. Baek MS, Cha MJ, Kim MC, et al. Clinical and radiological findings of adult hospitalized patients with community-acquired pneumonia from SARS-CoV-2 and endemic human coronaviruses. PLoS One. 2021;16(1):e0245547. DOI:10.1371/journal.pone.0245547
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58. Wei J, Alfajaro MM, DeWeirdt PC, et al. Genome-wide CRISPR Screens Reveal Host Factors Critical for SARS-CoV-2 Infection. Cell. 2021;184(1):76-91.e13. DOI:10.1016/j.cell.2020.10.028
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12. Huang L, Li X, Gu X, et al. Health outcomes in people 2 years after surviving hospitalisation with COVID-19: a longitudinal cohort study. Lancet Respir Med. 2022;10(9):863-76. DOI:10.1016/S2213-2600(22)00126-6
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22. Caruso D, Guido G, Zerunian M, et al. Post-Acute Sequelae of COVID-19 Pneumonia: Six-month Chest CT Follow-up. Radiology. 2021;301(2):E396-405. DOI:10.1148/radiol.2021210834
23. Ravaglia C, Doglioni C, Chilosi M, et al. Clinical, radiological and pathological findings in patients with persistent lung disease following SARS-CoV-2 infection. Eur Respir J. 2022;60(4):2102411. DOI:10.1183/13993003.02411-2021
24. Aesif SW, Bribriesco AC, Yadav R, et al. Pulmonary Pathology of COVID-19 Following 8 Weeks to 4 Months of Severe Disease: A Report of Three Cases, Including One With Bilateral Lung Transplantation. Am J Clin Pathol. 2021;155(4):506-14. DOI:10.1093/ajcp/aqaa264
25. Konopka KE, Perry W, Huang T, et al. Usual Interstitial Pneumonia is the Most Common Finding in Surgical Lung Biopsies from Patients with Persistent Interstitial Lung Disease Following Infection with SARS-CoV-2. EClinicalMedicine. 2021;42:101209. DOI:10.1016/j.eclinm.2021.101209
26. Swank Z, Senussi Y, Manickas-Hill Z, et al. Persistent Circulating Severe Acute Respiratory Syndrome Coronavirus 2 Spike Is Associated With Post-acute Coronavirus Disease 2019 Sequelae. Clin Infect Dis. 2023;76(3):e487-90. DOI:10.1093/cid/ciac722
27. Proal AD, VanElzakker MB. Long COVID or Post-acute Sequelae of COVID-19 (PASC): An Overview of Biological Factors That May Contribute to Persistent Symptoms. Front Microbiol. 2021;12:698169. DOI:10.3389/fmicb.2021.698169
28. Phetsouphanh C, Darley DR, Wilson DB, et al. Immunological dysfunction persists for 8 months following initial mild-to-moderate SARS-CoV-2 infection. Nat Immunol. 2022;23(2):210-6. DOI:10.1038/s41590-021-01113-x
29. Zubchenko S, Kril I, Nadizhko O, et al. Herpesvirus infections and post-COVID-19 manifestations: a pilot observational study. Rheumatol Int. 2022;42(9):1523-30. DOI:10.1007/s00296-022-05146-9
30. Liu Q, Mak JWY, Su Q, et al. Gut microbiota dynamics in a prospective cohort of patients with post-acute COVID-19 syndrome. Gut. 2022;71(3):544-52.
DOI:10.1136/gutjnl-2021-325989
31. Yeoh YK, Zuo T, Lui GC, et al. Gut microbiota composition reflects disease severity and dysfunctional immune responses in patients with COVID-19. Gut. 2021;70(4):698-706. DOI:10.1136/gutjnl-2020-323020
32. Wallukat G, Hohberger B, Wenzel K, et al. Functional autoantibodies against G-protein coupled receptors in patients with persistent Long-COVID-19 symptoms. J Transl Autoimmun. 2021;4:100100. DOI:10.1016/j.jtauto.2021.100100
33. Su Y, Yuan D, Chen DG, et al. Multiple early factors anticipate post-acute COVID-19 sequelae. Cell. 2022;185(5):881-95.e20. DOI:10.1016/j.cell.2022.01.014
34. Arthur JM, Forrest JC, Boehme KW, et al. Development of ACE2 autoantibodies after SARS-CoV-2 infection. PLoS One. 2021;16(9):e0257016. DOI:10.1371/journal.pone.0257016
35. Charfeddine S, Ibn Hadj Amor H, Jdidi J, et al. Long COVID-19 Syndrome: Is It Related to Microcirculation and Endothelial Dysfunction? Insights From TUN-EndCOV Study. Front Cardiovasc Med. 2021;8:745758. DOI:10.3389/fcvm.2021.745758
36. Pretorius E, Venter C, Laubscher GJ, et al. Prevalence of symptoms, comorbidities, fibrin amyloid microclots and platelet pathology in individuals with Long COVID/Post-Acute Sequelae of COVID-19 (PASC). Cardiovasc Diabetol. 2022;21(1):148. DOI:10.1186/s12933-022-01579-5
37. Spudich S, Nath A. Nervous system consequences of COVID-19. Science. 2022;375(6578):267-9. DOI:10.1126/science.abm2052
38. Ehab A, Reissfelder F, Laufer J, et al. Transbronchial lung cryobiopsy performed in acute COVID-19 pneumonia: first report. Adv Respir Med. 2021;89(1):72-4. DOI:10.5603/ARM.a2021.0032
39. De Gopegui Miguelena PR, Chamarro MP, Vega LMC. Afectación endotelial por Covid-19 en criobiopsia pulmonar. Archivos de Bronconeumología. 2020;57:65. DOI:10.1016/j.arbres.2020.06.010
40. Doglioni C, Ravaglia C, Rossi G, et al. Acute Lung injury evolution in Covid-19. MedRxiv. 2020. DOI:10.1101/2020.08.09.20170910
41. Barisione E, Grillo F, Ball L, et al. Fibrotic progression and radiologic correlation in matched lung samples from COVID-19 post-mortems. Virchows Arch. 2021;478(3):471-85. DOI:10.1007/s00428-020-02934-1
42. Su Y, Yuan D, Chen DG, et al. Multiple early factors anticipate post-acute COVID-19 sequelae. Cell. 2022;185(5):881-95.e20. DOI:10.1016/j.cell.2022.01.014
43. Bastard P, Gervais A, Le Voyer T, et al. Autoantibodies neutralizing type I IFNs are present in ~4% of uninfected individuals over 70 years old and account for ~20% of COVID-19 deaths. Sci Immunol. 2021;6(62):eabl4340. DOI:10.1126/sciimmunol.abl4340
44. Wang C, Wang Z, Wang G, et al. COVID-19 in early 2021: current status and looking forward. Signal Transduct Target Ther. 2021;6(1):114. DOI:10.1038/s41392-021-00527-1
45. Bone RC. Toward a theory regarding the pathogenesis of the systemic inflammatory response syndrome: what we do and do not know about cytokine regulation. Crit Care Med. 1996;24(1):163-72. DOI:10.1097/00003246-199601000-00026
46. Chang S, Pierson E, Koh PW, et al. Mobility network models of COVID-19 explain inequities and inform reopening. Nature. 2021;589(7840):82-7. DOI:10.1038/s41586-020-2923-3
47. Parasa S, Desai M, Thoguluva Chandrasekar V, et al. Prevalence of Gastrointestinal Symptoms and Fecal Viral Shedding in Patients With Coronavirus Disease 2019: A Systematic Review and Meta-analysis. JAMA Netw Open. 2020;3(6):e2011335. DOI:10.1001/jamanetworkopen.2020.11335
48. Hotchkiss RS, Monneret G, Payen D. Immunosuppression in sepsis: a novel understanding of the disorder and a new therapeutic approach. Lancet Infect Dis. 2013;13(3):260-8. DOI:10.1016/S1473-3099(13)70001-X
49. Sugimoto MA, Sousa LP, Pinho V, et al. Resolution of Inflammation: What Controls Its Onset? Front Immunol. 2016;7:160. DOI:10.3389/fimmu.2016.00160
50. Bozza FA, Salluh JI, Japiassu AM, et al. Cytokine profiles as markers of disease severity in sepsis: a multiplex analysis. Crit Care. 2007;11(2):R49. DOI:10.1186/cc5783
51. Pretorius L, Kell DB, Pretorius E. Iron Dysregulation and Dormant Microbes as Causative Agents for Impaired Blood Rheology and Pathological Clotting in Alzheimer's Type Dementia. Front Neurosci. 2018;12:851. DOI:10.3389/fnins.2018.00851
52. Fitridge R, Thompson M, eds. Mechanisms of Vascular Disease: A Reference Book for Vascular Specialists. Adelaide (AU): University of Adelaide Press, 2011.
53. Hamers L, Kox M, Pickkers P. Sepsis-induced immunoparalysis: mechanisms, markers, and treatment options. Minerva Anestesiol. 2015;81(4):426-39.
54. Walton AH, Muenzer JT, Rasche D, et al. Reactivation of multiple viruses in patients with sepsis. PLoS One. 2014;9(2):e98819. DOI:10.1371/journal.pone.0098819
55. Xu K, Cai H, Shen Y, et al. Management of COVID-19: the Zhejiang experience. Zhejiang Da Xue Xue Bao Yi Xue Ban. 2020;49(2):147-57. DOI:10.3785/j.issn.1008-9292.2020.02.02
56. Baek MS, Cha MJ, Kim MC, et al. Clinical and radiological findings of adult hospitalized patients with community-acquired pneumonia from SARS-CoV-2 and endemic human coronaviruses. PLoS One. 2021;16(1):e0245547. DOI:10.1371/journal.pone.0245547
57. Di Felice G, Visci G, Teglia F, et al. Effect of cancer on outcome of COVID-19 patients: a systematic review and meta-analysis of studies of unvaccinated patients. Elife. 2022;11:e74634. DOI:10.7554/eLife.74634
58. Wei J, Alfajaro MM, DeWeirdt PC, et al. Genome-wide CRISPR Screens Reveal Host Factors Critical for SARS-CoV-2 Infection. Cell. 2021;184(1):76-91.e13. DOI:10.1016/j.cell.2020.10.028
59. Truong TT, Ryutov A, Pandey U, et al. Increased viral variants in children and young adults with impaired humoral immunity and persistent SARS-CoV-2 infection: A consecutive case series. EBioMedicine. 2021;67:103355. DOI:10.1016/j.ebiom.2021.103355
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Авторы
Г.Е. Баймаканова*1, М.В. Самсонова1,2, А.Л. Черняев2–4, А.С. Конторщиков3, А.С. Белевский4
1ГБУЗ «Московский клинический научно-практический центр им. А.С. Логинова» Департамента здравоохранения г. Москвы, Москва, Россия;
2ФГБУ «Научно-исследовательский институт пульмонологии» ФМБА России, Москва, Россия;
3ФГБНУ «Российский научный центр хирургии им. акад. Б.В. Петровского», Москва, Россия;
4ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России, Москва, Россия
*g.baymakanova@mknc.ru
1Loginov Moscow Clinical Scientific Center, Moscow, Russia;
2Research Institute of Pulmonology, Moscow, Russia;
3Petrovsky National Research Centre of Surgery, Moscow, Russia;
4Pirogov Russian National Research Medical University, Moscow, Russia
*g.baymakanova@mknc.ru
1ГБУЗ «Московский клинический научно-практический центр им. А.С. Логинова» Департамента здравоохранения г. Москвы, Москва, Россия;
2ФГБУ «Научно-исследовательский институт пульмонологии» ФМБА России, Москва, Россия;
3ФГБНУ «Российский научный центр хирургии им. акад. Б.В. Петровского», Москва, Россия;
4ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России, Москва, Россия
*g.baymakanova@mknc.ru
________________________________________________
1Loginov Moscow Clinical Scientific Center, Moscow, Russia;
2Research Institute of Pulmonology, Moscow, Russia;
3Petrovsky National Research Centre of Surgery, Moscow, Russia;
4Pirogov Russian National Research Medical University, Moscow, Russia
*g.baymakanova@mknc.ru
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