medjournalМедицинский журналMedical Journal1818-426XБелорусский государственный медицинский университет10.51922/1818-426X.2026.3.120medjournal-458Research ArticleОРИГИНАЛЬНЫЕ НАУЧНЫЕ ПУБЛИКАЦИИORIGINAL SCIENTIFIC PUBLICATIONSВыявление лабораторных критериев стратификации риска тромбоза у пациентов с COVID-19IDENTIFICATION OF LABORATORY CRITERIA FOR RISK STRATIFICATION OF THROMBOSIS IN PATIENTS WITH COVID-19ХрыщановичВ. Я.KhryshchanovichV. Y.

Минск

Minsk

РоговойН. А.RogovoyN. A.

Минск

Minsk

ГончарикА. В.GoncharikA. V.

Минск

Minsk

КартунЛ. В.KartunL. V.

Минск

Minsk

ХодосовскаяЕ. В.KhodosovskayaE. V.

Минск

Minsk

ИбрагимоваЖ. А.IbragimovaZh. A.

Минск

Minsk

СкобелеваН. Я.SkobelevaN. Y.

Минск

Minsk

УО «Белорусский государственный медицинский университет»БеларусьBelarussian State Medical UniversityBelarusУЗ «Клинический родильный дом Минской области»БеларусьClinical Maternity Hospital of Minsk RegionBelarus20262407202603120125Copyright © Хрыщанович В.Я., Роговой Н.А., Гончарик А.В., Картун Л.В., Ходосовская Е.В., Ибрагимова Ж.А., Скобелева Н.Я., 20262026Хрыщанович В.Я., Роговой Н.А., Гончарик А.В., Картун Л.В., Ходосовская Е.В., Ибрагимова Ж.А., Скобелева Н.Я.Khryshchanovich V.Y., Rogovoy N.A., Goncharik A.V., Kartun L.V., Khodosovskaya E.V., Ibragimova Z.A., Skobeleva N.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://medjournal.ejournal.by/jour/article/view/458

Артериальные и венозные тромботические события являются частым осложнением COVID-19-инфекции, что часто утяжеляет течение и прогноз основного заболевания. В настоящем исследовании установлены лабораторные критерии стратификации риска тромбоза глубоких вен (ТГВ) у пациентов с COVID-19, которые могут быть использованы для раннего назначения или своевременной коррекции антикоагулянтной терапии.

Цель исследования – разработать прогностические лабораторные критерии высокого риска COVID-ассоциированного тромбоза.

Материал и методы

Материал и методы. Определяли динамику уровней биомаркеров воспаления, эндотелиальной дисфункции и антифосфолипидных антител в трех группах пациентов: COVID-19-позитивных (COV), с COVID-ассоциированным тромбозом (COV-ТГВ) и с ТГВ без инфекции SARS-CoV2 (ТГВ). Производили забор образцов периферической крови у 143 пациентов: 13 пациентов с COV-ТГВ, 85 пациентов с COV и 36 пациентов с ТГВ. Методом иммуноферментного анализа было проанализировано содержание маркеров эндотелиальной дисфункции фактора фон Виллебранда (VWF) и тканевого активатора плазминогена (t-PA); антител к фосфолипидам – волчаночному антикоагулянту (SSB) и белку, связывающему маннозу (MBL). Выполняли определение содержания антител к фосфолипидам (к β2-гликопротеину I IgM/IgG, к кардиолипину IgM/IgG). Проводили сравнительный анализ уровней провоспалительных цитокинов (интерлейкина 1-бета [ИЛ-1β], интерлейкина 6 [ИЛ-6], интерлейкина 10 [ИЛ-10] и противовоспалительного цитокина (фактора некроза опухолей-альфа [ФНО-α]).

Результаты

Результаты. В исследуемых группах в начале заболевания было обнаружено, что у COVID-19-позитивных пациентов были достоверно выше уровни SSB, VWF, MBL, ФНО-α и ИЛ-10 по сравнению с пациентами с ТГВ. В случае сравнения этих же показателей в группе COV с пациентами с COV-ТГВ достоверно выше был только уровень VWF и MBL. Анализ уровня антител к фосфолипидам показал, что у COVID-19позитивных пациентов при поступлении были достоверно выше уровни антител к β2-гликопротеину I IgM и кардиолипину IgG по сравнению с пациентами с ТГВ, а в случае сравнения показателей в группе COVID-19-позитивных пациентов с пациентами с COVID+ТГВ достоверная разница обнаружена только в уровне антител к кардиолипину IgG.

Заключение

Заключение. Для стратификации риска ТГВ у пациентов с COVID-19-инфекцией наибольшей прогностической значимостью обладают интерлейкин-6, маркер эндотелиальной дисфункции VWF и антитела к кардиолипину IgG.

Arterial and venous thrombotic events are a common complication of COVID infection, often complicating the course and prognosis of the primary disease. This study presents laboratory criteria for stratifying the high risk of deep vein thrombosis (DVT) in patients with COVID-19, which can be used for early prediction of DVT in order to prescribe or timely adjust anticoagulant therapy.

The aim of the study was to develop prognostic laboratory criteria for the degree of risk of COVID-associated thrombosis.

Material and methods

Material and methods. We determined the dynamics of biomarker levels of inflammation, endothelial dysfunction, and antiphospholipid antibodies in three groups of patients: COVID-19positive (COV), with COVID-associated thrombosis (COV-DVT), and with DVT without SARS-CoV2 infection (DVT). Peripheral blood samples were collected and analyzed from 143 patients: 13 patients with COV-DVT, 85 patients with COV, and 36 patients with DVT. The levels of markers of endothelial dysfunction, von Willebrand factor (VWF) and tissue plasminogen activator (t-PA) were analyzed using enzyme immunoassay, antibodies to phospholipids – lupus anticoagulant (SSB) and mannose-binding protein (MBL). The levels of antibodies to phospholipids (to β2-glycoprotein I IgM/IgG, to cardiolipin IgM/IgG) was determined. A comparative analysis of the levels of proinflammatory cytokines (interleukin 1-beta [IL-1β], interleukin 6 [IL-6], interleukin 10 [IL-10]) and anti-inflammatory cytokine (tumor necrosis factor-alpha [TNF-α]) was performed.

Results

Results. In the patient groups studied, it was found that at the onset of the disease, COVID-positive patients had significantly higher levels of SSB, VWF, MBL, TNF-α, and IL-10 compared to patients with DVT. When comparing these same indicators in the COV group with patients with COV-DVT, only the levels of VWF and MBL were significantly higher. Analysis of phospholipid antibody levels showed that COVID-positive patients had significantly higher levels of antibodies to β2-glycoprotein I IgM and cardiolipin IgG at admission compared to patients with DVT, and when comparing the indicators in the group of COVID-positive patients with patients with COV-DVT, a significant difference was found only in the level of antibodies to cardiolipin IgG.

Conclusion

Conclusion. For stratifying the risk of DVT in patients with COVID-19 infection, interleukin-6, the marker of endothelial dysfunction VWF, and IgG antibodies to cardiolipin are of highest prognostic significance.

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The authors declare that there are no conflicts of interest present.