Патофизиологические аспекты поражения ротовой полости при COVID-19
DOI:
https://doi.org/10.54500/2790-1203-2023-4-119-55-66Ключевые слова:
COVID-19, патология ротовой полости, патофизиология, патогенетический факторАннотация
Пандемия COVID-19, вызванная коронавирусом SARS-CoV-2 открывает путь к более чем тысячи серьезных патологий различных органов и систем, в том числе и ротовой полости.
Цель обзора: систематический анализ научных статей и выявление основных патогенетических факторов поражения ротовой полости при COVID-19. В данном исследовании проводился поиск на платформах PubMed и Google Scholar с использованием следующей стратегии: «COVID-19» + «Oral cavity». Были проанализированы все статьи, находящиеся в открытом доступе, опубликованные до 01.03.2022 в формате описания случая, клинических и многоцентровых исследований.
Всего 135 публикаций были включены в исследование после исключения повторов, проанализировано 33 518 случаев. Поражения зубов, языка, твердого неба и слизистой полости рта, дисгевзия, ксеростомия и агевзия - наиболее частые проявления COVID-19 (17137 случаев). Предполагаемые механизмы дисгевзии у пациентов с COVID-19 включают прямое цитотоксичное действие вируса на вкусовые рецепторы, экспрессирующие АПФ-2, дисбалас ангиотензина II, периферический нейротропизм вкусовых и обонятельных нервов. Слюнные железы с высокой экспрессией АПФ-2 также являются мишенью для COVID-19, их поражение вызывает ксеростомию с последующей дисгевзией. Первичное поражение слизистой полости рта проявлялось в виде множественных эритем и отека (29 случаев). Язвы вследсвие прикуса слизистой, вызванного сокращением мышц, раздражения посторонним предметом во время интубации способствуют травматизации полости рта и могут вести к развитию новообразований от доброкачественной фибромы до агрессивной формы рака, особенно на фоне приема кортикостероидов (3 случая). Дефицит витамина D способствует снижению плотности челюстно-лицевой кости, и служит фактором миграции зубов и периодонтита. Присоединение вторичной инфекции наблюдается в связи с подавлением иммунной системы, как самим вирусом, так и медикаментами. Зарегистрированы псевдомембранозный кандидоз (3 случая), рецидивирующий простой герпес (3 случая), saccharomyces cerevisiae (2 случая) и прочее.
Проведенный анализ показывает, что поражение ротовой полости может возникнуть как следствие прямого действия COVID-19, так и опосредованно, через психоэмоциональный стресс, прием антибактериальных препаратов, коинфекцию, пренебрежение мерами гигиены, дефицит витамина Д и цинка.
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