DOSADAŠNJA SAZNANJA O ETIOPATOGENEZI I MOGUĆNOSTIMA TERAPIJE KOVID-19
Sažetak
Trenutno je u svetu od Kovida-19 obolelo preko 35 miliona ljudi, a preko milion je umrlo. Pandemijski
karakter bolesti je nametnuo dinamična istraživanja, kako u oblasti razjašnjavanja etiopatogenetskih
mehanizama bolesti, tako i u oblasti moguće terapije. Količina naučnih znanja se u poslednjih devet
meseci nekoliko desetina puta uvećala, ali i dalje nismo ni blizu definisanju efikasne i sigurne terapije.
Saznanje da je Kovid-19 ne samo respiratorno, već i multisistemsko oboljenje, koje zahvata skoro
sve organe, dalo nam je mogućnosti za terapijska prilagođavanja. Jak oksidacioni stres, tiha hronična
hipoksija, povećana koagulabilnost i povećana agregacija trombocita, samo su neki od mehanizama
u razvoju bolesti. Smatra se da su kardiovaskularne posledice i poremećaj funkcije endotela krvnih
sudova uglavnom odgovorni za smrtni ishod, uz opasnu citokinsku oluju i akutni respiratorni distres
sindrom. Imajući sve ovo u vidu, u terapijskom smislu, kod već obolelih osoba, predložena je primena
antibiotika, visokih doza vitamina C zbog antioksidacionog dejstva, transfuzije krvi, imunoglobulina,
interferona, anti-IL-6 antitela, malih doza deksametazona ili drugih kortikosteroida, specifičnih
antivirusnih lekova, favipiravira i remdesivira. Primena hlorokina isključena je iz terapijskih protokola
Svetske zdravstvene organizacije i američkih Centara za kontrolu i prevenciju bolesti. U preventivne i
suportivne svrhe savetuju se visoke doze vitamina D, vitamina C, cinka, probiotika, alfalipoinske kiseline
i drugih suplemenata. Primena antinflamatornih analgo-antipiretika smatra se opravdanom, kao i
primena malih doza acetilsalicilne kiseline. Preko 70 drugih lekova se trenutno ispituje u preko 400
kliničih studija. Kod pacijenata koji već inhalatorno ili intranazalno koriste kortikosteroide zbog astme,
hronične opstruktivne bolesti pluća, alergijskog rinitisa, ili biološke lekove zbog imunomodulisanih
inflamatornih bolesti, ovu terapiju ne treba menjati i ona nije preduslov za teže oblike bolesti. Moraju
se uzeti u obzir i specifičnosti infekcije kod posebnih populacija kakve su deca ili trudnice.
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