asurgeryАмбулаторная хирургияAmbulatornaya khirurgiya = Ambulatory Surgery (Russia)2712-87412782-2591ООО «ГРУППА РЕМЕДИУМ»10.21518/1995-1477-2022-19-2asurgery-300Research ArticleФЛЕБОЛОГИЯPHLEBOLOGYCOVID-19-ассоциированная флебопатия как актуальная проблема современной флебологииCOVID-19-associated phlebopathy as a current problem of modern phlebologyhttps://orcid.org/0000-0002-3940-0787БогачевВ. Ю.BogachevV. Yu.

Богачев Вадим Юрьевич - доктор медицинских наук, профессор кафедры факультетской хирургии №2, РНИМУ имени Н.И. Пирогова ; хирург-флеболог, Первый флебологический центр.

117997, Москва, ул. Островитянова, д. 1; 117447, Москва, ул. Дмитрия Ульянова, д. 31

Vadim Yu. Bogachev - Dr. Sci. (Med.), Professor, Department of Faculty Surgery No. 2, Pirogov RNRMU; Vascular Surgeon, First Phlebological Center1, Ostrovityanov St., Moscow, 117997; 31, Dmitry Ulyanov St., Moscow, 117447

vadim.bogachev63@gmail.comhttps://orcid.org/0000-0003-4488-9123БолдинБ. В.BoldinB. V.

Болдин Борис Валентинович - доктор медицинских наук, профессор, заведующий кафедрой факультетской хирургии №2.

117997, Москва, ул. Островитянова, д. 1

Boris V. Boldin - Dr. Sci. (Med.), Professor, Head of the Department of Faculty Surgery No. 2.

1, Ostrovityanov St., Moscow, 117997

facultysurgery@gmail.comhttps://orcid.org/0000-0002-6262-4770ТуркинП. Ю.TurkinP. Yu.

Туркин Павел Юрьевич - кандидат медицинских наук, доцент кафедры факультетской хирургии №2, РНИМУ имени Н.И. Пирогова; хирург-флеболог, Первый флебологический центр.

117997, Москва, ул. Островитянова, д. 1; 117447, Москва, ул. Дмитрия Ульянова, д. 31

Pavel Yu. Turkin - Cand. Sci. (Med.), Associate Professor, Department of Intermediate Level Surgery No. 2, Pirogov RNRMU; Vascular Surgeon, First Phlebological Center.

1, Ostrovityanov St., Moscow, 117997; 31, Dmitry Ulyanov St., Moscow, 117447

pavelturkin@gmail.comhttps://orcid.org/0000-0003-3811-5156ДженинаО. В.DzheninaO. V.

Дженина Ольга Вадимовна - кандидат медицинских наук, врач-хирург, сосудистый хирург.

117447, Москва, ул. Дмитрия Ульянова, д. 31

Olga V. Dzhenina, Cand. Sci. (Med.), Surgeon, Vascular Surgeon.

31, Dmitry Ulyanov St., Moscow, 117447

helgelman@mail.ruРоссийский национальный исследовательский медицинский университет имени Н.И. Пирогова; Первый флебологический центрРоссияPirogov Russian National Research Medical University; First Phlebological CenterRussian FederationРоссийский национальный исследовательский медицинский университет имени Н.И. ПироговаРоссияPirogov Russian National Research Medical UniversityRussian FederationПервый флебологический центрРоссияFirst Phlebological CenterRussian Federation2022181120221921320Copyright © Богачев В.Ю., Болдин Б.В., Туркин П.Ю., Дженина О.В., 20222022Богачев В.Ю., Болдин Б.В., Туркин П.Ю., Дженина О.В.Bogachev V.Y., Boldin B.V., Turkin P.Y., Dzhenina O.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.a-surgeon.ru/jour/article/view/300Материалы и методы

Материалы и методы. 178 пациентов (125 женщин), средний возраст 34,8 ± 3,2 года, перенесшие SARS-CoV-2, по поводу впервые возникших веноспецифических жалоб получали микронизированную очищенную флавоноидную фракцию (МОФФ) 1 000 мг в сутки в течение 90 дней. Мониторинг жалоб осуществляли с помощью 10-сантиметровой визуальной аналоговой шкалы и опросника CIVIQ-20. Всем пациентам было выполнено ультразвуковое обследование венозной системы обеих нижних конечностей и фотоплетизмография. 30 больным до и после лечения проведено лабораторное биохимическое исследование с определением уровней маркеров эндотелиальной дисфункции.

Результаты

Результаты. Через 90 дней флеботропной терапии отмечено значимое уменьшение выраженности всех веноспецифических жалоб, за исключением расширения внутрикожных вен. Глобальный индекс качества жизни повысился с 64,4 ± 11,2 до 86,6 ± 9,1% (p < 0,001). Отмечено улучшение показателей фотоплетизмографии (ФПГ). Время возвратного кровенаполнения и сила мышечно-венозной помпы голени значимо (p < 0,05) увеличились, соответственно, на 4,3 сек и 3,5%. У 30 пациентов, которым было проведено биохимическое исследование в первых образцах крови, полученных из большой подкожной вены, обнаружено существенное увеличение концентрации IL-1 (7,8 ± 0,7 пг/мл), IL-6 (18,7 ± 1,8 пг/мл), VEGF (187,8 ± 11,6 пг/мл), TNF (7,8 ± 0,9 пг/мл), гистамина (22,4 ± 11,4 нмоль/л) и hsСРБ (5,4 ± 0,3 мг/л), что свидетельствует о формировании провоспалительного фенотипа венозного эндотелия. Через 90 дней приема МОФФ эти показатели значимо уменьшились. Уровни IL-1 и IL-6 снизились на 3,2 и 10,4 пг/мл соответственно, значения VEGF и TNF упали на 114,6 пг/мл и 2,9 пг/мл. Отмечена постепенная нормализация показателей гистамина и hsСРБ до 6,1 ± 4,1 нмоль/л и 1,1 ± 0,9 мг/л.

Выводы

Выводы. Полученные данные свидетельствуют, что появление веноспецифических симптомов и синдромов у пациентов, перенесших SARS-CoV-2, может быть обусловлено развитием флебопатии, коррекция которой требует применения фармакологических препаратов с актуальными механизмами действия.

Введение

Введение. SARS-CoV-2 сопровождается развитием дисфункции венозного эндотелия, которая может привести к развитию персистирующей флебопатии нижних конечностей, снижаю щей качество жизни пациентов.

Цель

Цель. Оценить эффективность фармакологической терапии пациентов с постковидной флебопатией.

Introduction

Introduction. SARS-CoV-2 is accompanied by the development of venous endothelial dysfunction, which can lead to the development of persistent phlebopathy of the lower limbs, reducing the quality of life of patients.

Objective

Objective. To evaluate the efficacy of pharmacological therapy in patients with postcocclusive phlebopathy.

Materials and methods

Materials and methods. 178 patients (125 women), mean age 34.8 ± 3.2 years, who underwent SARS-CoV-2, for their first veno-specific complaints received micronized purified flavonoid fraction (MPFF) 1,000 mg per day for 90 days. Complaints were monitored using a 10-cm visual analog scale and the CIVIQ-20 questionnaire. All patients underwent ultrasound examination of the venous system of both lower extremities and photoplethysmography. Laboratory biochemical examination with determination of endothelial dysfunction marker levels was performed in 30 patients before and after treatment.

Results

Results. After 90 days of phlebotropic therapy, there was a significant reduction in the severity of all venous-specific complaints, except for intradermal vein dilation. The global quality of life index increased from 64.4 ± 11.2 to 86.6 ± 9.1% (p < 0.001). There was an improvement in photoplethysmography (PPG) scores. Return blood-flow time and tibial venous muscle pump strength increased significantly (p < 0.05) by 4.3 s and 3.5%, respectively. The 30 patients who underwent biochemical examination in the first blood samples obtained from the great saphenous vein showed a significant increase in IL-1 concentration (7.8 ± 0, 7 pg/ml), IL-6 (18.7 ± 1.8 pg/ml), VEGF (187.8 ± 11.6 pg/ml), TNF (7.8 ± 0.9 pg/ml), histamine (22.4 ± 11.4 nmol/L) and hsCRB (5.4 ± 0.3 mg/L), indicating that a proinflammatory phenotype of venous endothelium was formed. After 90 days of MOFF administration, these indices significantly decreased. The levels of IL-1 and IL-6 decreased by 3.2 and 10.4 pg/ml, respectively, the values of VEGF and TNF decreased by 114.6 pg/ml and 2.9 pg/ml. There was a gradual normalization of histamine and hsCRB to 6.1 ± 4.1 nmol/L and 1.1 ± 0.9 mg/L.

Conclusions

Conclusions. The data obtained indicate that the appearance of veno-specific symptoms and syndromes in patients who have undergone SARS-CoV-2 may be due to the development of phlebopathy, the correction of which requires the use of pharmacological drugs with relevant mechanisms of action.

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