Terapevticheskii arkhivTerapevticheskii arkhivТерапевтический архив0040-36602309-5342LLC Obyedinennaya Redaktsiya6487810.26442/00403660.2021.02.200613ReviewsОбзорыResearch ArticleNew approaches to the pathogenesis, clinic, and treatment of hepatic encephalopathyНовые подходы к патогенезу, клинике, лечению печеночной энцефалопатииhttps://orcid.org/0000-0002-2313-9748PodymovaS. D.ПодымоваСветлана Дмитриевна
Russian Federation

д.м.н., проф., вед. науч. сотр. отд. гепатологии

spodymova@yandex.ruLoginov Moscow Clinical Research and Practical CenterГБУЗ «Московский клинический научно-практический центр им. А.С. Логинова» Департамента здравоохранения г. Москвы150220219322362420604202106042021Copyright ©; 2021, Consilium MedicumCopyright ©; 2021, ООО "Консилиум Медикум"2021Consilium MedicumООО "Консилиум Медикум"https://creativecommons.org/licenses/by-nc-sa/4.0https://ter-arkhiv.ru/0040-3660/article/view/64878

This review article presents new approaches to the assessment of key pathogenesis factors, clinical features, and treatment of hepatic encephalopathy (HE) associated with liver cirrhosis. Various clinical variants of the course of HE in patients with cirrhosis of the liver areconsidered, which are important for the choice of treatment and prevention of repeated relapses of HE. Analyzed the ammonia hypothesis of pathogenesis and associated hyperammonemia, which is the basis of most modern treatment methods. These data on the activation of the adaptive pathway for removing ammonia in the form of glutamine are used in the further study of drugs that enhance the clearance of ammonia. The possibility of reducing GABA-ergic tone due to the effect of the antagonist on the neurosteroid site in the GABA receptor complex is emphasized.

В обзорной статье представлены новые подходы к оценке ключевых факторов патогенеза, клинических особенностей и лечения печеночной энцефалопатии (ПЭ), связанной с циррозом печени. Рассматриваются различные клинические варианты течения ПЭ у больных циррозом печени, которые важны для выбора лечения и профилактики повторных рецидивов ПЭ. Анализируется аммиачная гипотеза патогенеза и связанная с ней гипераммонемия, положенная в основу большинства современных методов лечения. Приведенные данные об активации адаптивного пути удаления аммиака в виде глутамина находят применение в дальнейшем изучении препаратов, усиливающих клиренс аммиака. Подчеркивается возможность снижения ГАМКергического тонуса за счет воздействия антагониста на нейростероидный участок в комплексе рецепторов ã-аминомасляной кислоты.

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