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Российский журнал гастроэнтерологии, гепатологии, колопроктологии

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Диарея у пациентов с инфекцией COVID-19

https://doi.org/10.22416/1382-4376-2020-30-6-51-56

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Аннотация

Цель обзора: рассмотреть возможные причины диареи у больных с инфекцией COVID-19.
Основные положения. Помимо респираторных симптомов, у пациентов с инфекцией COVID-19 могут наблюдаться и жалобы со стороны желудочно-кишечного тракта, среди которых ведущее место занимает диарея. Данные о ее частоте колеблются от 2 до 40 %. Причины возникновения диареи могут быть связаны с непосредственным взаимодействием вируса с рецепторами ангиотензин-превращающего фермента 2 (АСЕ2) слизистой оболочки кишечника, его влиянием на кишечную микробиоту, побочными эффектами проводимой терапии. Возможность диареи выступать в качестве ведущего клинического симптома коронавирусной инфекции затрудняет своевременную диагностику заболевания. Данные литературы о влиянии диареи на течение инфекции COVID-19 противоречивы.
Заключение: эпидемиологические и клинические аспекты данной проблемы требуют дальнейших исследований.

Об авторе

А. А. Шептулин
ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет) Министерства здравоохранения Российской Федерации
Россия

Шептулин Аркадий Александрович — доктор медицинских наук, профессор кафедры пропедевтики внутренних болезней Института клинической медицины им. Н.В. Склифософского

119991, г. Москва, ул. Погодинская, д. 1, стр. 1



Список литературы

1. Ивашкин В.Т., Шептулин А.А., Зольникова О.Ю., Охлобыстин А.В., Полуэктова Е.А., Трухманов А.С., и др. Новая коронавирусная инфекция (COVID-19) и система органов пищеварения. Рос журн гастроэнтерол гепатол колопроктол. 2020;30(3):7–13. DOI: 10.22416/1382-4376-2020-30-3-7

2. D’Amico F., Baumgart D.C., Danese S., Peyrin-Biroulet L. Diarrhea during COVID-19 infection: pathogenesis, epidemiology, prevention, and management. Clin Gastroenterol Hepatol. 2020;18(8):1663–72. DOI: 10.1016/j.cgh.2020.04.001

3. Chen N., Zhou M., Dong X., Qu J., Gong F., Han Y., et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507–13. DOI: 10.1016/S0140-6736(20)30211-7

4. Guan W.J., Ni Z.Y., Hu Y., Liang W.H., Ou C.Q., He J.X., et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382(18):1708–20. DOI: 10.1056/NEJMoa2002032

5. Xu X.W., Wu X.X., Jiang X.G., Xu K.J., Ying L.J., Ma C.L., et al. Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-Cov-2) outside of Wuhan, China: retrospective case series. BMJ. 2020;368:m606. DOI: 10.1136/bmj.m606

6. Liu K., Fang Y.Y., Deng Y., Liu W., Eang M.F., Ma J.P., et al. Clinical characteristics of novel coronavirus cases in tertiary hospitals in Hubei province. Chin Med J (Engl). 2020;133(9):1025–31. DOI: 10.1097/CM9.0000000000000744

7. Zheng T., Yang C., Wang H.Y., Chen X., Yu L., Wu C.L., Sun H. Clinical characteristics and outcomes of COVID-19 patients with gastrointestinal symptoms admitted to Jianghan Fangcang Shelter Hospital in Wuhan, China. J Med Virol. 2020; 10.1002/jmv.26146. DOI: 10.1002/jmv.26146

8. Cheung K.S., Hung I.F.N., Chan P.P.Y., Tso E., Liu R., Ng Y.Y., et al. Gastrointestinal manifestations of SARS-CoV-2 infection and virus load in fecal samples from a Hong Kong cohort: systematic review and meta-analysis. Gastroenterology. 2020;S0016-5085(20)30448-0. DOI: 10.1053/j.gastro.2020.03.065

9. Park S.K., Lee C.W., Park D.I., Woo H.Y., Cheong H.S., Shin H.C., et al. Detection of SARSCoV-2 in fecal samples from patients with asymptomatic and mild COVID-19 in Korea. Clin Gastroenterol Hepatol. 2020;S1542-3565(20)30777-1. DOI: 10.1016/j.cgh.2020.06.005

10. Zhao X.Y., Xu X.X., Yin H.S., Hu Q.M., Xiong T., Tang Y.Y., et al. Clinical characteristics of patients with 2019 coronavirus disease in a non-Wuhan area of Hubei province, China: a retrospective study. BMC Infect Dis. 2020;20(1):311. DOI: 10.1186/s12879-020-05010-w

11. Lin L., Jiang X., Zhang., Huang S., Zhang Z., Fanf Z., et al. Gastrointestinal symptoms of 95 cases with SARSCoV-2 infection. 2020;69(6):997–1001. DOI: 10.1136/gutjnl-2020-321013

12. Wei X.S., Wang X., Niu J.C., Ye L.L., Peng W.B., Wang Z.H. et al. Diarrhea is associated with prolonged symptoms and viral carriage in corona virus disease 2019. Clin Gastroenterol Hepatol. 2020;18(8):1753–9.e2. DOI: 10.1016/j.cgh.2020.04.030

13. Han C., Duan C., Zhang S., Spiegel B., Shi H., Wang W., et al. Digestive symptoms in COVID-19 patients with mild disease severity: clinical presentation, stool viral RNA testing, and outcomes. Am J Gastroenterol. 2020;115(6):916–23. DOI: 10.14309/ajg.0000000000000664

14. Zayet S., Kadiane-Oussou N.J., Lepiller Q., Zahra H., Royer P.Y., Toko L., et al. Clinical features of COVID-19 and influenza: a comparative study on Nord Franche-Comte cluster. Microbes Infect. 2020;S1286-4579(20)30094-0. DOI: 10.1016/j.micinf.2020.05.016

15. Rokkas T. Gastrointestinal involvement in COVID-19: a systematic review and meta-analysis. Ann Gastroenterol. 2020;33(4):355–65. DOI: 10.20524/aog.2020.0506

16. Wang H., Qui P., Liu J., Wang F., Zhao Q. The liver injury and gastrointestinal symptoms in patients with coronavirus disease-19: A systematic review and metaanalysis. Clin Res Hepatol Gastroenterol. 2020;S22107401(20)30117-0. DOI: 10.1016/j.clinre.2020.04.012

17. Wan S., Mingqi L., Ye Z., Yang C., Cai Q., Duan S., Song B. CT manifestations and clinical characteristics of 1115 Patients with coronavirus disease 2019 (COVID-19): a systematic review and meta-analysis. Acad Radiol. 2020;27(7):910–21. DOI: 10.1016/j.acra.2020.04.033

18. Parasa S., Desai M., Thoguluva C., Patel H.K., Kennedy K.F., Roesch T., et al. Prevalence of gastrointestinal symptoms and fecal viral shedding in patients with coronavirus disease 2019: A systematic review and meta-analysis. JAMA Netw Open. 2020;3(6):e2011335. DOI: 10.1001/jamanetworkopen.2020.11335

19. Xiao F., Tang M., Zheng X., Liu Y., Li X., Shan H. Evidence for gastrointestinal infection of SARS-CoV-2. Gastroenterology. 2020:S0016-5085(20)30282-1. DOI: 10.1053/j.gastro.2020.02.055

20. Zhang H., Li H.B., Lyu J.R., Lei X.M., Li W., Wu G., et al. Specific ACE2 expression in small intestinal enterocytes may cause gastrointestinal symptoms and injury after 2019-nCoV infection. Int J Infect Dis. 2020;96:19–24. DOI: 10.1016/j.ijid.2020.04.027

21. Viana S.D., Nunes S., Reis F. ACE2 imbalance as a key player for the poor outcomes in COVID-19 patients with age-related comorbidities — Role of gut microbiota dysbiosis. Ageing Res Rev. 2020;62:101123. DOI: 10.1016/j.arr.2020.101123

22. Barlow A., Landolf K.M., Barlow B., Yeung S.Y.A.Y., Heavner J.J., Claassen C.W., Heavner M.C. Review of emerging pharmacotherapy for the treatment of coronavirus disease 2019. Pharmacotherapy. 2020;40(5):416–37. DOI: 10.1002/phar.2398

23. Tang W., Cao Z., Han M., Wang Z., Chen J., Sun W., et al. Hydroxychloroquine in patients with COVID-19: an open-label, randomized, controlled trial. medRxiv. 2020. DOI: 10.1101/2020.04.10.20060558

24. Million M., Lagier J.C., Gautret P., Colson P., Fournier P.E., Amrane S., et al. Early treatment of COVID-19 patients with hydroxychloroquine and azithromycin: A retrospective analysis of 1061 cases in Marseille, France. Travel Med Infect Dis. 2020;35:101738. DOI: 10.1016/j.tmaid.2020.101738

25. Damle B., Vourvahis M., Wang E., Leaney J., Corrigan D. Clinical pharmacology perspectives on the antiviral activity of azithromycin and use in COVID-19. Clin Pharmacol Ther. 2020:10.1002/cpt.1857.

26. Lagier J.C., Million M., Gautret P., Colson P., Cortaredona S., Giraud-Gatineau A., et al. Outcomes of 3,737 COVID-19 patients treated with hydroxychloroquine/azithromycin and other regimens in Marseille, France: A retrospective analysis. Travel Med Infect Dis. 2020;36:101791. DOI: 10.1016/j.tmaid.2020.101791

27. Yin J., Prabhakar M., Wang S., Liao S.-X., Peng X., He Y., et al. Different dynamic patterns of β-lactams, quinolones, glycopeptides and macrolides on mouse gut microbial diversity. PLoS One. 2015;10(5):e0126712. DOI: 10.1371/journal.pone.0126712

28. Sandhu A., Tillotson G., Polistico J., Salimnia H., Cranis M., Moshos L., et al. Clostridioides difficile in COVID-19 patients, Detroit, Michigan, USA, MarchApril 2020. Emerg Infect Dis. 2020;26(9):2272–4. DOI: 10.3201/eid2609.202126

29. Song Y., Liu P., Shi X.L., Chu J.L., Zhang J., Xia J., et al. SARS-CoV-2 induced diarrhoea as onset symptom in patient with COVID-19. Gut. 2020;69:1143–4. DOI: 10.1136/gutjnl-2020-320891

30. Yang X., Zhao J., Yan Q., Zhang Sh., Wang Y., Li Y. A case of COVID-19 patient with the diarrhea as initial symptom and literature review. Clin Res Hepatol Gastroenterol. 2020; S2210-7401(20)30085-1. DOI: 10.1016/j.clinre.2020.03.013

31. Ata F., Almasri H., Sajid J., Yousaf Z. COVID-19 presenting with diarrhoea and hyponatraemia. BMJ Case Rep. 2020;13(6):e235456. DOI: 10.1136/bcr-2020-235456

32. Holshue M.L., DeBolt C., Lindquist S., Lofy K.H., Wiesman J., Bruce H., et al. First case of 2019 novel coronavirus in the United States. N Engl J Med. 2020;382(10):929–36. DOI: 10.1056/NEJMoa2001191

33. Ai J.W., Zi H., Wang Y., Huang Q., Wang N., Li L.Y., et al. Clinical characteristics of COVID-19 patients with gastrointestinal symptoms: an analysis of seven patients in China. Front Med (Lausanne). 2020;7:308. DOI: 10.3389/fmed.2020.00308

34. Eder P., Lodyga M., Dobrovolska A., Rydzewska G., Kamhieh-Milz J. Addressing multiple gastroenterological aspects of coronavirus disease 2019. Pol Arch Intern Med. 2020;130(5):420–30. DOI: 10.20452/pamw.15332

35. Jin X., Lian J.S., Hu J.H., Gao J., Zheng L., Zhang Y.M., et al. Epidemiological, clinical and virological characteristics of 74 cases of coronavirus-infected disease 2019 (COVID-19) with gastrointestinal symptoms. Gut. 2020;69(6):1002–9. DOI: 10.1136/gutjnl-2020-320926

36. Wang X., Zhou Y., Jiang N., Zhou Q., Ma V.L. Persistence of intestinal SARS-CoV-2 infection in patients with COVID-19 leads to re-admission after pneumonia resolved. Int J Infect Dis . 2020;95:433–5. DOI: 10.1016/j.ijid.2020.04.063

37. Сholanceril G., Podboy A., Aivaliotas V., Pham E.A., Tarlow B., Spencer S., et al. Association of digestive symptoms and hospitalization in patients with SARSCoV-2 infection. MedRxiv. 2020;2020.04.23.20076935. DOI: 10.1101/2020.04.23.20076935

38. Zhang H., Liao Y.S., Gong J., Liu J., Xia X., Zhang H. Clinical characteristics of coronavirus disease (COVID-19) patients with gastrointestinal symptoms: A report of 164 cases. Dig Liver Dis. 2020;S1590-8658(20)30189-4. DOI: 10.1016/j.dld.2020.04.034

39. Gul F., Lo K.B., Peterson J., McCullough P.A., Goyal A., Rangaswami J. Meta-analysis of outcomes of patients with COVID-19 infection with versus without gastrointestinal symptoms. Proc (Bayl Univ Med Cent). 2020;33(3):366–9. DOI: 10.1080/08998280.2020.1771164

40. Wang D., Hu B., Hu C., Zhu F., Liu X., Zhang J., et al. Clinical сharacteristics of 138 hospitalized patients with 2019 novel coronavirus — infected pneumonia in Wuhan, China. JAMA. 2020;323(11):1061–9. DOI: 10.1001/jama.2020.1585

41. Gao Q.Y., Chen Y.X., Fang J.Y. 2019 Novel coronavirus infection and gastrointestinal tract. J Dig Dis. 2020;21(3):125–6. DOI: 10.1111/1751-2980.12851


Для цитирования:


Шептулин А.А. Диарея у пациентов с инфекцией COVID-19. Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2020;30(6):51-56. https://doi.org/10.22416/1382-4376-2020-30-6-51-56

For citation:


Sheptulin A.A. Diarrhoea in Patients with COVID-19. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2020;30(6):51-56. (In Russ.) https://doi.org/10.22416/1382-4376-2020-30-6-51-56

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