Статья
Возможности комбинированной терапии на раннем этапе течения новой коронавирусной инфекции (COVID-19). Разбор клинических случаев и дизайн исследования: Бромгексин И Спиронолактон для лечения КоронаВирусной Инфекции, Требующей госпитализации (БИСКВИТ)
Статья посвящена вопросу эффективного лечения новой коронавирусной инфекции (COVID-19) на ранних стадиях болезни. Обосновывается необходимость противовирусной терапии и снижения вирусной нагрузки с целью не допустить прогрессирования инфекции. Констатируется отсутствие специфической противовирусной терапии именно в отношении вируса SARS-CoV-2. Разбираются результаты первых рандомизированных исследований по применению лопинавира / ритонавира, ремдесивира и фавипиравира при COVID-19, и их потенциал в лечении новой коронавирусной инфекции. Среди препаратов, блокирующих вход вируса в клетки, наибольшее внимание было уделено противомалярийным препаратам хлорохину и гидроксихлорохину. В статье подробно анализируются неэффективность, а также потенциальная опасность гидроксихлорохина, не показавшего снижения сроков клинического восстановления и улучшения прогноза больных с COVID-19. Главной темой является обоснование возможности применения муколитического и противокашлевого препарата бромгексина, блокирующего трансмембранную сериновую протеазу 2, необходимую для проникновения вируса SARS-CoV-2 в клетки. Аналогичным свойством может обладать и спиронолактон, который за счет антиандрогенных эффектов блокирует связанные с Х-хромосомой синтез рецепторов АПФ-2 и активизацию трансмембранной сериновой протеазы 2. Кроме замедления входа в клетки, спиронолактон уменьшает выраженность фиброза различных органов, в том числе легких. Основная часть статьи посвящена клиническим примерам ведения пациентов в Университетской клинике МНОЦ МГУ имени М. В. Ломоносова, в том числе с успешным использованием схемы лечения пациентов с COVID 19, включающей в себя бромгексин и спиронолактон. В заключении приводится дизайн рандомизированного проспективного исследования БИСКВИТ, проводившегося в Университетской клинике МГУ. Его целью явилось изучение эффективности предложенной схемы.
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