Avtoimunski, biokemijski in hematološki laboratorijski parametri bolnikov s postcovidnim sindromom

Šabec, Neža (author), Čučnik, Saša (mentor), Meško Brguljan, Pika (comentor)

Virus SARS-CoV-2, ki povzroča COVID-19, za vstop v gostiteljsko celico izkorišča receptor ACE2, ki je prisoten predvsem v pljučnih celicah. Okužba sproži kompleksne patofiziološke mehanizme, vključno s prekomernim vnetjem, motnjami koagulacije in disfunkcijo žilnega endotelija. Bolezen COVID-19 se kaže s pestro klinično sliko. Večina preboli asimptomatsko, v manjšem deležu povzroča pljučnico, tudi večorgansko odpoved, citokinsko nevihto in akutni respiratorni distresni sindrom. Vse več ljudi po prebolelem COVID-19 poišče pomoč zaradi dolgotrajnih težav, najpogosteje utrujenosti in dispneje. Skupek teh simptomov, ki običajno trajajo več kot dva meseca po okužbi, opredeljujemo kot pocovidni sindrom, ki prizadene 10–30 % nehospitaliziranih bolnikov. Pri laboratorijski diagnostiki so opazili vnetne spremembe, kot so zvišani AST, D-dimer, citokini ter limfocitopenija. V razvoj pocovidnega sindroma so lahko vključeni tudi avtoimunski procesi s tvorbo avtoprotiteles (ANA, ANCA, aCL, anti-β2GPI). Vključeni preiskovanci so bili del raziskave z naslovom »Vpliv okužbe s SARS-CoV 2 na funkcijo avtonomnega živčevja pri odraslih bolnikih«; katerim smo izvedli biokemijske, hematološke preiskave, osnovno analizo urina, preiskave za oceno hemostaze, določali avtoprotitelesa (anti-ENA, HEp-2, anti-β2GPI, aCL) v dveh časovnih točkah (ob prvem pregledu v ambulanti in po najmanj 168 dneh) ter primerjali značilnosti s kontrolno skupino zdravih krvodajalcev. Hkrati pa smo želeli najti potencialni laboratorijski označevalec pocovidnega sindroma. V nalogi smo prišli do zaključka, da je delež bolnikov s pocovidnim sindromom, ki imajo pridružene bolezni, 54 %. Najpogostejša simptoma sta slaba zmogljivost in dispneja. Mediane parametrov (troponin T, prosti T3 in T4, direktni bilirubin, AST, ALT, gama-GT, kreatinin, levkociti, hemoglobin …) s statistično pomembno razliko so znotraj orientacijskih referenčnih intervalov. Koncentracija IL-6 je bila zvišana pri osebah s pocovidnimi simptomi pri drugem pregledu v primerjavi z osebami kontrolne skupine. Pozitivne vrednosti HEp-2 so bile pri osebah s pocovidnim sindromom 25 %, pri osebah kontrolne skupine 17,4 %. Vrednosti aCL in anti-β2GPI se ne spreminjajo glede na časovno okno. Pri določanju HEp-2 in anti-ENA smo določili porast titra pri osebah s pocovidnim sindromom glede na kontrolno skupino. Simptomi se glede na časovno okno med pregledoma zmanjšujejo, a ne izzvenijo popolnoma. Večina preiskav ni pokazala pomembne povezave s pocovidnim sindromom.

• Language: Slovenian
• Keywords: COVID-19, pocovidni sindrom, SARS-CoV 2, vztrajanje simptomov, avtoimunska protitelesa
• Work type: Master's thesis/paper
• Typology: 2.09 - Master's Thesis
• Organization: FFA - Faculty of Pharmacy
• Year: 2025
• PID: 20.500.12556/RUL-175481
• COBISS.SI-ID: 256732163
• Publication date in RUL: 29.10.2025

Secondary language

• Language: English
• Title: Autoimmune, biochemical, and haematological laboratory parameters in patients with post-COVID syndrome

Abstract

The SARS-CoV-2 virus uses the ACE2 receptor to enter host cells, mainly found in lung cells. The infection triggers complex pathophysiological mechanisms, including hyperinflammation, coagulopathy, endothelial dysfunction. Disease COVID-19 manifests with a diverse clinical picture. While most individuals experience asymptomatic infection, some develop pneumonia, and some may experience multi-organ failure, cytokine storm and acute respiratory distress syndrome. An increasing number of people visit medical help after recovering from COVID-19 due to persistent symptoms, most commonly fatigue and shortness of breath. This cluster of symptoms, typically lasting more than two months after infection, is defined as post-COVID syndrome, affecting 10–30% of non-hospitalized patients. Laboratory tests revealed inflammatory changes, including elevated AST, D-dimer, cytokines, and lymphocytopenia. Post-COVID syndrome may involve autoimmune processes with the production of autoantibodies (ANA, ANCA, aCL, anti-β2GPI). The participants were part of the research "Impact of SARS-CoV-2 Infection on the Function of the Autonomic Nervous System in Adult Patients", underwent biochemical, hematological tests, basic urine analysis, hemostasis tests, and determination of autoantibodies (anti-ENA, HEp-2, anti-β2GPI, aCL) at two time points (initial visit and at least 168 days later), comparing results with healthy blood donor controls. At the same time, we aimed to identify a potential laboratory marker of post-COVID syndrome. We concluded that the proportion of patients with post-COVID syndrome who have comorbidities is 54%. The most common symptoms are fatigue and dyspnea. The median values of parameters (troponin T, free T3 and T4, direct bilirubin, AST, ALT, gamma-GT, creatinine, leukocytes, hemoglobin...) with statistically significant differences are within the reference ranges. IL-6 was elevated in post-COVID patients at the second exam versus controls. Positive HEp-2 was found in 25% of individuals with post-COVID syndrome and 17,4% of individuals in the control group. The titers of aCL and anti-β2GPI antibodies remained stable across the defined temporal window. Analysis of HEp-2 and anti-ENA antibody titers revealed a significant increase in individuals with post-COVID syndrome compared to the control group. The symptoms decrease over the time interval between examinations, but do not completely resolve. Most tests did not show a significant association with post-COVID syndrome.

• Keywords: COVID-19, post-COVID syndrome, SARS-CoV-2, persistence of symptoms, autoimmune antibodies