Annals of the Russian academy of medical sciencesAnnals of the Russian academy of medical sciencesВестник Российской академии медицинских наук0869-60472414-3545"Paediatrician" Publishers LLC141010.15690/vramn1410INFECTIOUS DISEASES: CURRENT ISSUESАКТУАЛЬНЫЕ ВОПРОСЫ ИНФЕКЦИОННЫХ БОЛЕЗНЕЙReview ArticleCOVID-19-associated secondary hemophagocytic lymphohistiocytosis (cytokine storm syndrome)COVID-19-ассоциированный вторичный гемофагоцитарный лимфогистиоцитоз (синдром «цитокинового шторма»)https://orcid.org/0000-0002-3874-47214713-9943AlekseevaEkaterina I.АлексееваЕкатерина Иосифовна
Russian Federation

MD, PhD, Professor, Corresponding Member of the RAS

д.м.н., профессор, член-корреспондент РАН

alekatya@yandex.ruhttps://orcid.org/0000-0001-6667-94723907-3234TepaevRustem F.ТепаевРустэм Фаридович
Russian Federation

MD, PhD

д.м.н.

tepaev@nczd.ruhttps://orcid.org/0000-0003-0369-95935826-6385ShilkrotIlia Y.ШилькротИлья Юрьевич
Russian Federation

MD, PhD

к.м.н.

7606399@gmail.comhttps://orcid.org/0000-0002-8165-64017524-7085DvoryakovskayaTatyana M.ДворяковскаяТатьяна Маратовна
Russian Federation

MD, PhD

д.м.н.

bzarova@nczd.ruhttps://orcid.org/0000-0001-6823-02732805-9855SurkovAleksander G.СурковАлександр Геннадьевич
Russian Federation

MD, PhD

к.м.н.

asurkov@1msmu.ruhttps://orcid.org/0000-0003-2370-3182KriulinIvan A.КриулинИван Алексеевич
Russian Federation

PhD Student

Аспирант

kriulin.vanya@yandex.ruNational Medical Research Center for Children’s HealthНациональный медицинский исследовательский центр здоровья детейI.M. Sechenov First Moscow State Medical University (Sechenov University)Первый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)National Association of Non-Governmental Medical OrganizationsНациональная ассоциация негосударственных медицинских организацийNational Medical Research Center for Children’s Health, MoscowНациональный медицинский исследовательский центр здоровья детей1204202176151660408202011032021Copyright ©; 2021, "Paediatrician" Publishers LLCCopyright ©; 2021, Издательство "Педиатръ"2021"Paediatrician" Publishers LLCИздательство "Педиатръ"https://vestnikramn.spr-journal.ru/jour/article/view/1410

In most cases, COVID-19 has a favorable outcome. However, the risk of developing critical forms of the disease, including secondary hemophagocytic lymphohistiocytosis – HLH (cytokine storm syndrome), remains high. This dictates the interest in studying pathogenetic mechanisms, features of the clinical picture, laboratory and instrumental criteria for covid-19 disease. The article analyzes the causes of acute respiratory distress syndrome and multiple organ failure as manifestations of HLH. The necessity of monitoring signs of hyperinflammation (ferritin, C-reactive protein, etc., biomarkers of inflammation) and activation of thrombosis is substantiated, in order to make timely decisions about the beginning of pathogenetic therapy. However, there are limitations for routine testing of the level of Pro-inflammatory cytokines. Information about the diagnostic criteria of HLH is summarized, and the expediency of these criteria for establishing secondary HLH, which has complicated the course of COVID-19, is emphasized.

В большинстве случаев COVID-19 отличается благоприятным исходом. Однако риск развития критических форм болезни, в том числе вторичного гемофагоцитарного лимфогистиоцитоза – ГЛГ (синдрома «цитокинового шторма»), остается высоким. Этим продиктован интерес к изучению патогенетических механизмов, особенностей клинической картины, лабораторных и инструментальных критериев тяжелого COVID-19. В статье проанализированы причины развития острого респираторного дистресс-синдрома и полиорганной недостаточности как проявлений ГЛГ. Обоснована необходимость мониторирования признаков гипервоспаления (ферритина, С-реактивного белка и пр. биомаркеров воспаления) и активации тромбообразования, для принятия своевременных решений о начале патогенетической терапии. Вместе с тем, отмечены ограничения для рутинного тестирования уровня провоспалительных цитокинов. Обобщены сведения о диагностических критериях ГЛГ, подчеркнута целесообразность этих критериев для установления вторичного ГЛГ, осложнившего течение COVID-19.

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