vestimИзвестия Национальной академии наук Беларуси. Серия медицинских наукProceedings of the National Academy of Sciences of Belarus, Medical series1814-60232524-2350The Republican Unitary Enterprise Publishing House "Belaruskaya Navuka"10.29235/1814-6023-2025-22-2-102-118vestim-1028Research ArticleКЛИНИЧЕСКАЯ И ЭКСПЕРИМЕНТАЛЬНАЯ МЕДИЦИНАCLINICAL AND EXPERIMENTAL MEDICINEИзменение морфометрических и нейрохимических показателей структур мозга у пациентов с постковидным синдромомChanges in morphometric and neurochemical parameters of brain structure in patients with post-COVID syndromehttps://orcid.org/0000-0003-0483-7329СтомаИ. О.StomaI. O.

Стома Игорь Олегович – д-р мед. наук, профессор, ректор.

Ул. Ланге, 5, 246000, Гомель

Igor O. Stoma – D. Sc. (Med.), Professor, Rector.

5, Lange Str., 246000, Gomel

gsmu@gsmu.byhttps://orcid.org/0000-0002-0665-0093БарановО. Ю.BaranovO. Yu.

Баранов Олег Юрьевич – член-корреспондент, д-р биол. наук, профессор, академик-секретарь.

Пр. Независимости, 66, 220072, Минск

Oleg Yu. Baranov – Corresponding Member, D. Sc. (Biol.), Professor, Academician-Secretary.

66, Nezavisimosti Ave., 220072, Minsk

biology@presidium.bas-net.byБеляковН. А.BelyakovN. A.

Беляков Николай Алексеевич – академик РАН, Действительный член РАН, д-р мед. наук, профессор, руководитель Северо-западного окружного центра по профилактике и борьбе со СПИД.

Ул. Мира, 14, 197101, Санкт-Петербург

Nikolay A. Belyakov – Academician of the Russian Academy of Sciences, Full Member of the Russian Academy of Sciences, D. Sc. (Med.), Professor, Head of the NorthWest District Center for the Prevention and Control of AIDS.

14, Mira Str., 197101, St. Petersburg

bmocspb@gmail.comhttps://orcid.org/0000-0002-1706-0144ГалиновскаяН. В.HalinouskayaN. V.

Галиновская Наталья Викторовна – д-р мед. наук, профессор, декан.

Ул. Ланге, 5, 246000, Гомель

Natalya V. Halinouskaya – D. Sc. (Med.), Professor, Dean.

5, Lange Str., 246000, Gomel

fpk@gsmu.byhttps://orcid.org/0000-0002-9435-6109ВоропаевЕ. В.VoropaevE. V.

Воропаев Евгений Викторович – канд. мед. наук, доцент, проректор по научной работе.

Ул. Ланге, 5, 246000, Гомель

Evgeniy V. Voropaev – Ph. D. (Med.), Associate Professor, Vice-Rector for Research.

5, Lange Str., 246000, Gomel

evoropaev@mail.ruhttps://orcid.org/0000-0002-1159-0101РассохинВ. В.RassokhinV. V.

Рассохин Вадим Владимирович – д-р мед. наук, вед. науч. сотрудник.

Ул. Мира, 14, 197101, Санкт-Петербург

Vadim V. Rassokhin – D. Sc. (Med.), Leading Researcher.

14, Mira Str., 197101, St. Petersburg

bmocspb@gmail.comhttps://orcid.org/0009-0004-9721-4511БобовичН. В.BobovichN. V.

Бобович Наталья Вячеславовна – врач лучевой диагностики.

Ул. Медицинская, 2, 246041, Гомель

Natalya V. Bobovich – Radiologist.

2, Meditsinskaya Str., 246041, Gomel

nbobo@mail.ruhttps://orcid.org/0000-0003-4360-4341БарбаровичА. А.BarbarovichA. A.

Барбарович Анастасия Александровна – ассистент.

Ул. Ланге, 5, 246000, Гомель

Anastasia A. Barbarovich – Assistant.

5, Lange Str., 246000, Gomel

Feniks-1342@mail.ruhttps://orcid.org/0000-0002-1931-4224ОсипкинаО. В.OsipkinaO. V.

Осипкина Ольга Викторовна – заведующий лабораторией.

Ул. Ланге, 5, 246000, Гомель

Olga V. Osipkina – Head of the Laboratory.

5, Lange Str., 246000, Gomel

olga.osipkina@mail.ruhttps://orcid.org/0000-0002-6123-2919НикифороваО. Л.NikiforovaO. L.

Никифорова Ольга Леонидовна – ст. преподаватель.

Ул. Ланге, 5, 246000, Гомель

Olga L. Nikiforova – Senior Lecturer.

5, Lange Str., 246000, Gomel

Nikiforova.O.L@yandex.ruГомельский государственный медицинский университетGomel State Medical UniversityОтделение биологических наук Национальной академии наук БеларусиDepartment of Medical Sciences of the National Academy of Sciences of BelarusСанкт-Петербургский научно-исследовательский институт эпидемиологии и микробиологии имени ПастераSaint-Petersburg Pasteur InstituteГомельский областной кинический онкологический диспансерGomel Regional Clinical Oncological Dispensary202528052025222102118Copyright © Стома И.О., Баранов О.Ю., Беляков Н.А., Галиновская Н.В., Воропаев Е.В., Рассохин В.В., Бобович Н.В., Барбарович А.А., Осипкина О.В., Никифорова О.Л., 20252025Стома И.О., Баранов О.Ю., Беляков Н.А., Галиновская Н.В., Воропаев Е.В., Рассохин В.В., Бобович Н.В., Барбарович А.А., Осипкина О.В., Никифорова О.Л.Stoma I.O., Baranov O.Y., Belyakov N.A., Halinouskaya N.V., Voropaev E.V., Rassokhin V.V., Bobovich N.V., Barbarovich A.A., Osipkina O.V., Nikiforova O.L.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vestimed.belnauka.by/jour/article/view/1028

Постковидный синдром представляет собой нечетко определенный симптомокомплекс преимущественно функциональных нарушений, который регистрируется у 30–70 % пациентов, перенесших инфекцию COVID-19.

Для определения патогенетических основ неврологических проявлений постковидного синдрома было обследовано с применением структурной магнитно-резонансной томографии (МРТ) и МРТ-спектроскопии 105 пациентов (46 мужчин и 59 женщин в возрасте 47 [40; 54,5] лет) с проявлениями постковидного синдрома через 3 мес. После перенесенного заболевания и 10 человек контрольной группы (4 мужчины и 6 женщин в возрасте 40 [28; 50] лет).

При разделении группы пациентов с постковидным синдромом на три подгруппы не выявлено значимых морфологических различий между структурами головного мозга по данным МРТ по мере нарастания жалоб, однако обнаружены межполушарная асимметрия в виде истончения коры головного мозга лобной доли слева ( p = 0,006) и расширение височного рога бокового желудочка справа ( p = 0,007) при значительной выраженности симптомов. Установлено снижение соотношения N-ацетиласпартат/креатинин (NAA/Cr) в передних отделах поясной извилины с обеих сторон ( p = 0,025) и в области семиовального центра справа ( p = 0,001), повышение соотношения холин/креатинин (Cho/Cr) в передних отделах поясной извилины с обеих сторон (справа при р < 0,01, слева при p = 0,04), прилежащих снаружи к зонам снижения соотношения NAA/Cr, снижение соотношения миоинозитол/креатинин в области семиовального центра справа ( p = 0,038) и в средних отделах поясной извилины слева ( p = 0,027).

Согласно функциональной топографии головного мозга, изменения нейромедиации в передних отделах поясной извилины и семиовального центра могут проявляться нарушением исполнительских функций, памяти и изменением настроения, что соответствует проявлениям постковидного синдрома.

Таким образом, нами выявлено, что в основе формирования неврологических проявлений постковидного синдрома лежат разнонаправленные изменения секреции NAA и Cho в поясной извилине головного мозга без сопутствующей им морфологической патологии.

Post-COVID syndrome is poorly defined complex of different symptoms predominantly functional disorders, which are diagnosed in 30–70 % of patients after COVID-19 infection.

To determine the pathogenic basis of neurological symptoms of post-COVID syndrome 105 patients (48 men, 40 women, mean age 47 [40; 54.5]) with post-COVID syndrome in the period from 3 months after COVID-infection and 10 people of the control group (4 men, 6 women, mean age 40 [28; 50]) were examined using structural magnetic resonance imaging (MRI) and magnetic resonance spectroscopy.

After dividing of post-COVID patients group into three subgroups according to the severity of complaints no significant morphological differences in brain structures were determined according to MRI data. However was revealed interhemispheric asymmetry as the cerebral cortex thinning in left frontal lobe ( p = 0.006) and higher left temporal horn of the side ventricle ( p = 0.007) in subgroup post COVID patients with severity symptoms. Was revealed decrease of the N-acetylaspartate/creatinine (NAA/Cr) ratio in the anterior part of the cingulate gyrus on both sides ( p = 0.025 on the right, p = 0.025 on the left) and in the center semiovale on the right sides ( p = 0.001), an increase of choline/creatinine (Cho/Cr) ratio in the anterior cingulate gyrus on both sides ( p < 0.01 on the right) and ( p = 0.04 on the left), right next to areas of decreased NAA/Cr ratio. It was also revealed decrease of the myoinositol/creatinine ratio in the center semiovale area on the right ( p = 0.038) and the middle cingulate gyrus on the left ( p = 0.027). According to the functional topography of the brain neuromediation changes in the anterior cingulate gyrus and center semiovale may have clinical correlates as impaired executive functions, memory and mood disturbance what is related to post-COVID syndrome.

Thus we found that neurological symptoms of post-COVID syndrome are based on multidirectional changes in the secretion of NAA and Cho in the cingulate gyrus of the brain without accompanying morphological pathology.

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