Reviu asupra imunopatofizologiei și biomarkerilor inflamatori în formele severe de COVID-19. De la mecanisme la aplicații clinice
DOI:
https://doi.org/10.52692/1857-0011.2025.2-82.33Cuvinte cheie:
forme severe de COVID-19, biomarkeri inflamatori, chemokine, ARDS, disfuncție imună, tocilizumabRezumat
Introducere. Formele severe de COVID-19 se caracterizează printr-o interacțiune complexă ce implică deteriorarea celulară indusă de acțiunea virusului, dezechilibre ale sistemului imunitar, afectarea endoteliului vascular și coagularea sanguină determinată de inflamație. Acest articol oferă o prezentare comprehensivă a principalelor mecanisme fiziopatologice, evidențiind importanța crucială a biomarkerilor inflamatori în procesul de diagnostic, stratificarea prognosticului și ghidarea terapeutică. Înțelegerea relației dintre aceste mecanisme și biomarkerii specifici permite o abordare mai personalizată în managementul pacienților cu COVID-19 în forme critice. Scopul articolului. Scopul acestui articol este de a realiza o sinteză amplă și actualizată a mecanisme de imunopatogeneză implicate în formele severe de COVID-19, punând accent pe identificarea și aplicabilitatea clinică abiomarkerilor inflamatori. Articolul urmărește să evidențieze modul în care acești biomarkeri pot fi utilizați în diagnostic, prognostic și ghidarea terapiei personalizate, contribuind astfel la optimizarea tratamentului pacienților critici și la reducerea mortalității asociate cu infecția SARS-CoV-2.Materiale și metode. Acest reviu a fost realizat prin căutarea sistematică și amplă a literaturii de specialitate publicată în perioada ianuarie 2020 și mai 2025, utilizând baze de date relevante (PubMed, Scopus, Web of Science, Google Scholar). Au fost incluși termeni de căutare precum: “COVID-19 sever”, “biomarkeri inflamatori”, “furtuna citokinică”, “disfuncție imună”, “CRP”, “IL-6”, “TNF-α”, “feritina”, “D-dimer”, “RAAS”, “ARDS”, “NETs”, “disfuncția endotelială”. Studiile incluse au fost selectate pe baza criteriilor de calitate, relevanță tematică, validitate metodologică și aplicabilitate clinică. Au fost excluse articolele non-științifice, cazurile pediatrice, comentariile și lucrările publicate în alte limbi decât engleza. Articolele selectate au fost grupate pe teme majore: patogenia, clasificarea biomarkerilor, utilitatea clinică și valoarea prognostică. Rezultate. Rezultatele analizei evidențiază faptul că severitatea COVID-19 este determinată de o interacțiune complexă între disfuncția endotelială, activarea imună excesivă, dezechilibrul RAAS și hipercoagulabilitate. Aceste mecanisme conduc la inflamație sistemică, imunotromboză și afectare multisistemică, în special pulmonară, renală, cardiacă și neurologică. Biomarkerii identificați - precum IL-6, CRP, D-dimer, TNF-α, feritina și CXCL10 - reflectă aceste procese și permit o evaluare dinamică a severității bolii. Studiile clinice au demonstrat că nivelurile crescute ale acestor markeri se corelează cu mortalitatea ridicată și răspunsul terapeutic variabil. Utilizarea biomarkerilor în ghidarea imunoterapiei a demonstrat beneficii semnificative în prognostic și individualizarea tratamentului.
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