sibmedСибирский научный медицинский журналСибирский научный медицинский журнал2410-25122410-2520ИЦиГ СО РАН10.18699/SSMJ20240101sibmed-1381Research ArticleСтатьиCOVID-19 и рассеянный склероз: есть ли связь?COVID-19 and multiple sclerosis: is there a connection?https://orcid.org/0000-0003-2740-6388АрхиповИ. Е.ArkhipovI. E.

Архипов Иван Евгеньевич 

630087, Новосибирск, ул. Немировича-Данченко, 130;630091, Новосибирск, Красный пр., 52

Ivan E. Arkhipov 

630087, Novosibirsk, Nemirovicha-Danchenko st., 130;630091, Novosibirsk, Krasny ave., 52

sicvel1739@list.ruhttps://orcid.org/0000-0003-2541-9302ПрокаеваА. И.ProkaevaA. I.

Прокаева Анна Ивановна 

630087, Новосибирск, ул. Немировича-Данченко, 130;630091, Новосибирск, Красный пр., 52;630090, Новосибирск, ул. Институтская, 3а

Anna I. Prokaeva 

630087, Novosibirsk, Nemirovicha-Danchenko st., 130;630091, Novosibirsk, Krasny ave., 52;630090, Novosibirsk, Institutskaya st., 3a

anna.teplyakova.95@mail.ruhttps://orcid.org/0000-0002-8863-2672ЗатеевА. В.ZateevA. V.

Затеев Антон Владимирови 

630091, Новосибирск, Красный пр., 52

Anton V. Zateev 

630091, Novosibirsk, Krasny ave., 52

https://orcid.org/0009-0001-2390-8332КозыреваВ. К.KozyrevaV. K.

Козырева Владислава Константиновна 

630091, Новосибирск, Красный пр., 52

Vladislava K. Kozyreva 

630091, Novosibirsk, Krasny ave., 52

https://orcid.org/0000-0002-7938-3782КоробкоД. С.KorobkoD. S.

Коробко Денис Сергеевич, к.м.н. 

630087, Новосибирск, ул. Немировича-Данченко, 130;630091, Новосибирск, Красный пр., 52;630090, Новосибирск, ул. Институтская, 3а

Denis S. Korobko, candidate of medical sciences 

630087, Novosibirsk, Nemirovicha-Danchenko st., 130;630091, Novosibirsk, Krasny ave., 52;630090, Novosibirsk, Institutskaya st., 3a

denis.s.korobko@gmail.comhttps://orcid.org/0000-0002-1255-8525МалковаН. А.MalkovaN. A.

Малкова Надежда Алексеевна, д.м.н. 

630087, Новосибирск, ул. Немировича-Данченко, 130;630091, Новосибирск, Красный пр., 52;630090, Новосибирск, ул. Институтская, 3а

Nadezhda A. Malkova, doctor of medical sciences 

630087, Novosibirsk, Nemirovicha-Danchenko st., 130;630091, Novosibirsk, Krasny ave., 52;630090, Novosibirsk, Institutskaya st., 3a

yadan1@mail.ruГосударственная Новосибирская областная клиническая больница; Новосибирский государственный медицинский университет Минздрава РоссииРоссияState Novosibirsk Regional Clinical Hospital; Novosibirsk State Medical University of Minzdrav of RussiaRussian FederationГосударственная Новосибирская областная клиническая больница; Новосибирский государственный медицинский университет Минздрава России; Институт «Международный томографический центр» СО РАНРоссияState Novosibirsk Regional Clinical Hospital; Novosibirsk State Medical University of Minzdrav of Russia; International Tomography Center of SB RASRussian FederationНовосибирский государственный медицинский университет Минздрава РоссииРоссияNovosibirsk State Medical University of Minzdrav of RussiaRussian Federation202427022024441714Copyright © Архипов И.Е., Прокаева А.И., Затеев А.В., Козырева В.К., Коробко Д.С., Малкова Н.А., 20242024Архипов И.Е., Прокаева А.И., Затеев А.В., Козырева В.К., Коробко Д.С., Малкова Н.А.Arkhipov I.E., Prokaeva A.I., Zateev A.V., Kozyreva V.K., Korobko D.S., Malkova N.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://sibmed.elpub.ru/jour/article/view/1381

Рассеянный склероз (РС) является хроническим иммуноопосредованным заболеванием центральной нервной системы (ЦНС), в основе которого лежат воспалительная демиелинизация и нейродегенерация. За время пандемии COVID-19 сложилось мнение, что вирус оказывает влияние на течение иммунных процессов. Обсуждаются вопросы, изменилась ли частота аутоиммунных заболеваний, в том числе нервной системы, и их течение. Цель исследования – оценка клинико-эпидемиологических характеристик РС в период пандемии COVID-19 с 01.01.2020 до 01.01.2023 в г. Новосибирске. В процессе работы мы изучили заболеваемость РС и особенности клинической картины дебюта РС, связанного с инфекцией COVID-19. Материал и методы. В исследование включены 628 пациентов с РС, проживающих в г. Новосибирске, с дебютом заболевания в период до пандемии с 01.01.2017 до 31.12.2019 (341 человек) и во время пандемии с 01.01.2020 до 01.1.2023 (287 больных). Результаты. Рассчитаны показатели заболеваемости РС в г. Новосибирске, которые в 2017, 2018, 2019, 2020, 2021 и 2020 гг. составили соответственно 7,1, 7,6, 6,4, 7,38, 6,92 и 3,2 на 100 тыс. населения. Средняя заболеваемость РС в исследуемый период до пандемии равнялась 7,03 на 100 тыс. населения, во время пандемии – 5,83 на 100 тыс. населения (p = 0,05). При анализе ассоциации клинических проявлений дебюта РС с COVID-19 установлено, что у больных с инфекцией средней степени тяжести чаще, чем у пациентов с инфекцией легкой степени тяжести, наблюдались координаторные нарушения (p < 0,05; отношение шансов 0,410, 95%-й доверительный интервал 0,162–1,035). Для пациентов с первично-прогрессирующим РС не показано статистически значимой корреляции клинических проявлений со степенью тяжести инфекции, однако отмечено преобладание многоочагового характера заболевания после более тяжелого течения COVID-19 (40 %). После первого клинического демиелинизирующего эпизода в группе пациентов с ремиттирующим РС шансы на полное восстановление у больных с легкой степенью течения инфекции в 2,8 раза выше, чем у пациентов с инфекцией, протекающей со средней степенью тяжести (p < 0,05). Выводы. В результате проведенного исследования не выявлено влияния COVID-19 на изменение заболеваемости РС. В процессе анализа клинических особенностей РС в период пандемии установлено, что перенесенная инфекция COVID-19 может способствовать неблагоприятному течению РС с худшим восстановлением неврологического дефицита после эпизодов обострений, что ведет к накоплению инвалидизации пациентов. 

Multiple sclerosis (MS) is a chronic immune-mediated disease of the central nervous system, which is based on inflammatory demyelination and neurodegeneration. Over the course of the COVID-19 pandemic, there has been a perception that the virus has an effect on the course of immune processes. The questions of whether the frequency of autoimmune diseases, including the nervous system, and their course has changed have been discussed. Aim of the study was to assess the clinical and epidemiological characteristics of MS during the COVID-19 pandemic from 01.01.2020 to 01.01.2023 in Novosibirsk. In the course of our work, we studied the incidence of MS and the features of the clinical picture of the debut of MS associated with COVID-19 infection. Material and methods. The study included 628 patients with MS living in Novosibirsk with the onset of the disease in the period before the pandemic from 01.01.2017 to 12/31/2019 (341 patients) and during the pandemic from 01.01.2020 to 01.1.2023 (287 patients). Results. The incidence rates of MS in Novosibirsk were calculated, it was 7.1 7.6 6.4 7.38 6.92 and 3.2 per 100 thousand population in 2017, 2018, 2019, 2020, 2021 and 2020, respectively. The average incidence of MS in the study period before the pandemic was 7.03 per 100 thousand population, during the pandemic – 5.83 per 100 thousand population (critical value of the Student’s t-test = 1.972, with a significance level of a = 0.05). When analyzing the association of clinical manifestations of the onset of MS with COVID-19, it was found that coordination disorders were observed in patients with moderate infection more often than in patients with mild infection (p < 0.05; odds ratio 0.410, 95% confidence interval 0.162–1.035). No statistically significant correlation of clinical manifestations with the severity of infection was shown for patients with primary progressive MS, however, the predominance of the multi-focal nature of disease after a more severe course of COVID-19 was noted (40 %). After the first clinical demyelinating episode in the group of patients with relapsing-remitting MS, the chances of complete recovery in patients with mild infection are 2.8 times higher than in patients with moderate infection (p < 0.05). Conclusions. Thus, as a result of the conducted study, the effect of COVID-19 on the change in the incidence of MS was not revealed. In the process of analyzing the clinical features of MS during the pandemic, it was found that COVID-19 infection can contribute to an unfavorable course of MS with worse recovery of neurological deficits after episodes of exacerbations, which leads to the accumulation of disability of patients.

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The authors declare that there are no conflicts of interest present.