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 <front>
  <journal-meta>
   <journal-id journal-id-type="publisher-id">Crimea Journal of Experimental and Clinical Medicine</journal-id>
   <journal-title-group>
    <journal-title xml:lang="en">Crimea Journal of Experimental and Clinical Medicine</journal-title>
    <trans-title-group xml:lang="ru">
     <trans-title>Крымский журнал экспериментальной и клинической медицины</trans-title>
    </trans-title-group>
   </journal-title-group>
   <issn publication-format="print">2224-6444</issn>
   <issn publication-format="online">2224-6452</issn>
  </journal-meta>
  <article-meta>
   <article-id pub-id-type="publisher-id">54938</article-id>
   <article-id pub-id-type="doi">10.29039/2224-6444-2021-11-3-77-84</article-id>
   <article-categories>
    <subj-group subj-group-type="toc-heading" xml:lang="ru">
     <subject>КЛИНИЧЕСКИЙ СЛУЧАЙ</subject>
    </subj-group>
    <subj-group subj-group-type="toc-heading" xml:lang="en">
     <subject>CLINICAL OBSERVATIONS</subject>
    </subj-group>
    <subj-group>
     <subject>КЛИНИЧЕСКИЙ СЛУЧАЙ</subject>
    </subj-group>
   </article-categories>
   <title-group>
    <article-title xml:lang="en">THE INFLUENCE OF IMMUNOTROPIC DRUGS ON THE CYTOKINE STORM IN CORONAVIRUS INFECTION (ON THE EXAMPLE OF A CLINICAL CASE)</article-title>
    <trans-title-group xml:lang="ru">
     <trans-title>ВЛИЯНИЕ ИММУНОТРОПНЫХ ПРЕПАРАТОВ НА ПРОТЕКАНИЕ ЦИТОКИНОВОГО ШТОРМА ПРИ КОРОНАВИРУСНОЙ ИНФЕКЦИИ (НА ПРИМЕРЕ КЛИНИЧЕСКОГО СЛУЧАЯ)</trans-title>
    </trans-title-group>
   </title-group>
   <contrib-group content-type="authors">
    <contrib contrib-type="author">
     <name-alternatives>
      <name xml:lang="ru">
       <surname>Землянухина</surname>
       <given-names>Ольга Александровна</given-names>
      </name>
      <name xml:lang="en">
       <surname>Zemlyanukhina</surname>
       <given-names>Olga Alexandrovna</given-names>
      </name>
     </name-alternatives>
     <email>oz54@mail.ru</email>
     <bio xml:lang="ru">
      <p>кандидат биологических наук;</p>
     </bio>
     <bio xml:lang="en">
      <p>candidate of sciences in biology;</p>
     </bio>
     <xref ref-type="aff" rid="aff-1"/>
    </contrib>
    <contrib contrib-type="author">
     <name-alternatives>
      <name xml:lang="ru">
       <surname>Остроушко</surname>
       <given-names>И. П.</given-names>
      </name>
      <name xml:lang="en">
       <surname>Ostroushko</surname>
       <given-names>I. P.</given-names>
      </name>
     </name-alternatives>
     <xref ref-type="aff" rid="aff-2"/>
    </contrib>
    <contrib contrib-type="author">
     <name-alternatives>
      <name xml:lang="ru">
       <surname>Суворова</surname>
       <given-names>И. М.</given-names>
      </name>
      <name xml:lang="en">
       <surname>Suvorova</surname>
       <given-names>I. M.</given-names>
      </name>
     </name-alternatives>
     <xref ref-type="aff" rid="aff-3"/>
    </contrib>
    <contrib contrib-type="author">
     <name-alternatives>
      <name xml:lang="ru">
       <surname>Кривошеева</surname>
       <given-names>Е. В.</given-names>
      </name>
      <name xml:lang="en">
       <surname>Krivosheeva</surname>
       <given-names>E. V.</given-names>
      </name>
     </name-alternatives>
     <xref ref-type="aff" rid="aff-4"/>
    </contrib>
    <contrib contrib-type="author">
     <name-alternatives>
      <name xml:lang="ru">
       <surname>Калаев</surname>
       <given-names>Владислав Николаевич</given-names>
      </name>
      <name xml:lang="en">
       <surname>Kalaev</surname>
       <given-names>Vladislav Nikolaevich</given-names>
      </name>
     </name-alternatives>
     <email>Dr_Huixs@mail.ru</email>
     <bio xml:lang="ru">
      <p>доктор биологических наук;</p>
     </bio>
     <bio xml:lang="en">
      <p>doctor of sciences in biology;</p>
     </bio>
     <xref ref-type="aff" rid="aff-5"/>
    </contrib>
    <contrib contrib-type="author">
     <name-alternatives>
      <name xml:lang="ru">
       <surname>Ларина</surname>
       <given-names>А. В.</given-names>
      </name>
      <name xml:lang="en">
       <surname>Larina</surname>
       <given-names>A. V.</given-names>
      </name>
     </name-alternatives>
     <xref ref-type="aff" rid="aff-5"/>
    </contrib>
    <contrib contrib-type="author">
     <name-alternatives>
      <name xml:lang="ru">
       <surname>Семенова</surname>
       <given-names>Е. Ф.</given-names>
      </name>
      <name xml:lang="en">
       <surname>Semenova</surname>
       <given-names>E. F.</given-names>
      </name>
     </name-alternatives>
     <xref ref-type="aff" rid="aff-6"/>
    </contrib>
   </contrib-group>
   <aff-alternatives id="aff-1">
    <aff>
     <institution xml:lang="ru">ФГБОУ ВО «Воронежский государственный университет»</institution>
     <city>Воронеж</city>
     <country>Россия</country>
    </aff>
    <aff>
     <institution xml:lang="en">Voronezh state University</institution>
     <city>Voronezh</city>
     <country>Russian Federation</country>
    </aff>
   </aff-alternatives>
   <aff-alternatives id="aff-2">
    <aff>
     <institution xml:lang="ru">Воронежская областная клиническая больница №1</institution>
     <country>Россия</country>
    </aff>
    <aff>
     <institution xml:lang="en">Воронежская областная клиническая больница №1</institution>
     <country>Russian Federation</country>
    </aff>
   </aff-alternatives>
   <aff-alternatives id="aff-3">
    <aff>
     <institution xml:lang="ru">Воронежская областная клиническая больница №1</institution>
     <country>Россия</country>
    </aff>
    <aff>
     <institution xml:lang="en">Воронежская областная клиническая больница №1</institution>
     <country>Russian Federation</country>
    </aff>
   </aff-alternatives>
   <aff-alternatives id="aff-4">
    <aff>
     <institution xml:lang="ru">Воронежская областная клиническая больница №1</institution>
     <country>Россия</country>
    </aff>
    <aff>
     <institution xml:lang="en">Воронежская областная клиническая больница №1</institution>
     <country>Russian Federation</country>
    </aff>
   </aff-alternatives>
   <aff-alternatives id="aff-5">
    <aff>
     <institution xml:lang="ru">Воронежский государственный университет</institution>
    </aff>
    <aff>
     <institution xml:lang="en">Voronezh State University</institution>
    </aff>
   </aff-alternatives>
   <aff-alternatives id="aff-6">
    <aff>
     <institution xml:lang="ru">Крымский Федеральный Университет им. В.И. Вернадского</institution>
     <country>RU</country>
    </aff>
    <aff>
     <institution xml:lang="en">V.I. Vernadsky Crimean Federal University</institution>
     <country>RU</country>
    </aff>
   </aff-alternatives>
   <pub-date publication-format="print" date-type="pub" iso-8601-date="2022-11-08T15:46:36+03:00">
    <day>08</day>
    <month>11</month>
    <year>2022</year>
   </pub-date>
   <pub-date publication-format="electronic" date-type="pub" iso-8601-date="2022-11-08T15:46:36+03:00">
    <day>08</day>
    <month>11</month>
    <year>2022</year>
   </pub-date>
   <volume>11</volume>
   <issue>3</issue>
   <fpage>77</fpage>
   <lpage>84</lpage>
   <history>
    <date date-type="received" iso-8601-date="2022-11-07T00:00:00+03:00">
     <day>07</day>
     <month>11</month>
     <year>2022</year>
    </date>
   </history>
   <self-uri xlink:href="https://ma.cfuv.ru/site/page/show/docid/260466">https://ma.cfuv.ru/site/page/show/docid/260466</self-uri>
   <abstract xml:lang="ru">
    <p>На примере одного клинического случая показано влияние 3 иммунотропных препаратов: гидроксихлорохина, тоцилизумаба,  артлегии  на  протекание  цитокинового  шторма  при  коронавирусной  инфекции.  Коронавирус относится к системной инфекции, поражая не только легкие и дыхательные пути, но и другие органы и системы: сердечно-сосудистую, иммунную и др. Тактика лечения зависела от кормобидного статуса пациента. В данном случае в анамнезе пожилой пациентки (66 лет) имелись бронхиальная астма и онкология. Пациентка была переведена в стационарные условия после 7 дней гипертермии (более 38°С). Наблюдались лимфопения, повышенная СОЭ (43 мм/час). Биохимические показатели также имели отклонения: уровень ЛДГ был равен 606  ед/л  (при  верхней  границе  нормы  450  ед/л),  уровень  ИЛ-6  был  повышен  незначительно  −  16.0  пг/мл (норма 0-10 пг/мл). На этой стадии заболевания применяли новоклав с целью предотвращения бактериальной инфекции,  дексаметазон,  цибор  −  антикоагулянт  прямого  действия,  гидроксихлорохин.  Через  неделю состояние пациентки значительно ухудшилось. Наблюдалась одышка, гипертермия держалась на уровне 38.5 °С, сатурация снизилась до 77 %, содержание ИЛ-6 превысило 300 пг/мл, прокальцитонина возросло до 0.5 мкг/л, С-реактивного белка до 67.5 мг/л, ферритина до 579 мг/мл, что соответствовало проявлению симптомов «цитокинового  шторма».  Однократное  введение  иммунотропного  препарата  тоцилизумаба  на  протяжении следующих трех суток не привело к снижению показателей. Пациентка была переведена на неинвазивную вентиляцию легких с одновременным введением другого, блокирующего непосредственно ИЛ-6 препарата, – артлегии в дозе 64 мг. В течение суток концентрация С-реактивного белка, уровень АСАТ и интерлейкина-6 снизились до нормы. Через неделю состояние пациентки стало удовлетворительным, и она была выписана из  стационара  с  поражением  легких  КТ-3.  Можно  говорить,  что  использование  клинических  биомаркеров воспаления (С-реактивного белка и ИЛ-6) позволяет выработать индивидуальный подход в лечении тяжелых случаев коронавирусной инфекции.</p>
   </abstract>
   <trans-abstract xml:lang="en">
    <p>On the example of one clinical case, the effects of three immunotropic drugs: hydroxychloroquine, tocilizumab, and arthlegia on the course of cytokine storm in coronavirus infection were shown. Coronavirus refers to a systemic infec- tion, affecting not only the lungs and respiratory tract, but also other organs and systems: cardiovascular, immune, etc. The tactics of treatment depended on the feeding status of the patient. In this case, an elderly female patient (66 years old) had bronchial asthma and oncology in the anamnesis. The patient was transferred to an inpatient setting after 7 days of abnormal temperature (above 38°C). Lymphopenia, increased ESR (43 mm/h) were observed. Biochemical parameters also had deviations: the level of LDG was 606 U/l (the upper limit of the norm of 450 U/l), the level of IL-6 was slightly increased - 16.0 pg/ml (the norm of 0-10 pg/ml). At this stage of the disease, Novoclav was used to prevent bacterial infection, Dexamethasone, Cibor, and Hydroxychloroquine. After a week, the patient’s condition worsened significantly. Shortness of breath was observed, body temperature remained at 38.5°C, saturation decreased to 77%, the content of IL-6 exceeded 300 pg/ml, procalcitonin increased to 0.5 μg/l, C-reactive protein - to 67.5 mg/l, ferritin&#13;
&#13;
– up to 579 mg/ml that appropriated to the manifestation of symptoms of cytokine storm. An administration of the im- munotropic drug Tocilizumab within the next three days did not cause the decrease of parameters. The patient was begun non-invasive ventilation of lungs with the simultaneous appointment of another blocker of IL-6 - arthlegia (64 mg). During a day, the concentration of C-reactive protein and IL-6 decreased to normal. A week later, the patient’s condition became satisfactory, and she was discharged from the hospital with CT3 pulmonary lesion. We can say that the use of clinical biomarkers of inflammation (C-reactive protein and IL-6) allows us to make an individual program in the treatment of severe cases of coronavirus infection.</p>
   </trans-abstract>
   <kwd-group xml:lang="ru">
    <kwd>коронавирус</kwd>
    <kwd>клинические проявления</kwd>
    <kwd>цитокиновый  шторм</kwd>
    <kwd>лечение</kwd>
    <kwd>иммуносупрессивные препараты</kwd>
    <kwd>гидроксихлорохин</kwd>
    <kwd>тоцилизумаб</kwd>
   </kwd-group>
   <kwd-group xml:lang="en">
    <kwd>coronavirus</kwd>
    <kwd>clinical signs</kwd>
    <kwd>cytokine storm</kwd>
    <kwd>therapy</kwd>
    <kwd>antiviral drugs</kwd>
    <kwd>Hydroxychloroquine</kwd>
    <kwd>Tocilizumab</kwd>
   </kwd-group>
  </article-meta>
 </front>
 <body>
  <p></p>
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