transplantologiyaТрансплантологияTransplantologiya. The Russian Journal of Transplantation2074-05062542-0909IPO Association of Transplantologists10.23873/2074-0506-2017-9-1-52-70transplantologiya-153Research ArticleОБЗОРНЫЕ СТАТЬИ И ЛЕКЦИИREVIEW ARTICLES AND LECTURESПарадокс: печеночная недостаточность «защищает» больного?Paradox: Does liver insuffi ciency protect the patient? A hypothesisДзядзькоА. М.Dzyadz'koA. M.

доцент, канд. мед. наук, заведующий отделом анестезиологии и реанимации

Минск, Республика Беларусь 

Associate Professor, Cand. Med. Sci., Head of the Anesthesiology and Intensive Care Department

Minsk, Republic of Belarus

2726996@gmail.comЩербаА. Е.ShcherbaA. E.

Минск, Республика Беларусь

Minsk, Republic of Belarus

РуммоО. О.RummoO. O.

Минск, Республика Беларусь

Minsk, Republic of Belarus

КатинМ. Л.KatinM. L.

Минск, Республика Беларусь

Minsk, Republic of Belarus

МиновА. Ф.MinovA. F.

Минск, Республика Беларусь

Minsk, Republic of Belarus

КоротковС. В.KorotkovS. V.

Минск, Республика Беларусь

Minsk, Republic of Belarus

ЧугуноваО. А.ChugunovaO. A.

Минск, Республика Беларусь

Minsk, Republic of Belarus

СантоцкийЕ. О.SantotskiyE. O.

Минск, Республика Беларусь

Minsk, Republic of Belarus

ЕфимовД. Ю.EfimovD. Yu.

Минск, Республика Беларусь

Minsk, Republic of Belarus

ГуроваМ. Ю.GurovaM. Yu.

Минск, Республика Беларусь

Minsk, Republic of Belarus

РНПЦ трансплантации органов и тканей УЗ «9-я Городская клиническая больница»РоссияThe Republican Scientific-Practical Center of Organ and Tissue Transplantation at the City Clinical Hospital No. 9Russian Federation201721032017915270Copyright © Дзядзько А.М., Щерба А.Е., Руммо О.О., Катин М.Л., Минов А.Ф., Коротков С.В., Чугунова О.А., Сантоцкий Е.О., Ефимов Д.Ю., Гурова М.Ю., 20172017Дзядзько А.М., Щерба А.Е., Руммо О.О., Катин М.Л., Минов А.Ф., Коротков С.В., Чугунова О.А., Сантоцкий Е.О., Ефимов Д.Ю., Гурова М.Ю.Dzyadz'ko A.M., Shcherba A.E., Rummo O.O., Katin M.L., Minov A.F., Korotkov S.V., Chugunova O.A., Santotskiy E.O., Efimov D.Y., Gurova M.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.jtransplantologiya.ru/jour/article/view/153

Несмотря на то, что ключевая роль печени в формировании иммунных реакций организма на повреждение не вызывает сомнений, механизмы ослабления иммунного ответа на инфекционное и неинфекционное повреждения у пациентов с печеночной недостаточностью остаются неясными. Представлена оригинальная гипотеза формирования путей ограничения амплитуды реакций системного воспалительного ответа у пациентов с терминальными стадиями заболеваний печени. Основой гипотезы является представление о том, что вследствие снижения интенсивности естественной стимуляции мембранных рецепторов mСD14 лигандами инфекционной природы нарушается основной механизм индукции системных иммунных реакций печеночными макрофагами (клетками Купфера), что, по мнению авторов, приводит к ограничениям интенсивности и амплитуды защитных иммунных реакций. Таким образом, объясняется ряд клинических феноменов, наблюдающихся у пациентов с печеночной недостаточностью/дисфункцией, заключающихся в сниженной реактивности организма в целом к повреждению инфекционными и неинфекционными агентами. Авторы считают возможным использование данной гипотезы для поиска новых направлений по предупреждению гиперреактивности иммунной системы при сепсисе, а также для коррекции лечебных стратегий ведения пациентов с высоким риском инфекционных осложнений после операции по трансплантации печени.

Despite the fact that the key role of the liver in the formation of the immune response to injury is not in doubt, the mechanisms of weakening the immune response to infectious and noninfectious lesions in patients with hepatic failure remain unclear. We propose an original hypothesis of forming the ways to limit the amplitude of the systemic inflammatory response in patients with the end-stage liver disease. The basis of the hypothesis is the idea that as a result of reducing the intensity of the natural stimulation of membrane mCD14 receptors by the ligands of infectious nature, the basic mechanism of the systemic immune response induction by liver macrophages (Kupffer cells) is interrupted. According to the proposed hypothesis, in condition of liver failure, the synthesis of lipopolysaccharide-binding protein by hepatocytes is reduced. This leads to a decreased amplitude and intensity of the protective immune responses. This fact explains a number of clinical phenomena observed in patients with liver failure/dysfunction that consist in a reduced reactivity of the organism to the damage inflicted by infectious and noninfectious agents. The authors consider it possible to use this hypothesis in the search for new trends to prevent the immune system hyper-reactivity in sepsis, and to improve the therapeutic strategies for the management of patients at high risk of infectious complications after liver transplantation.

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