rmtОбщая реаниматологияGeneral Reanimatology1813-97792411-7110FSBI "SRIGR" RAMS10.15360/1813-9779-2019-6-80-93rmt-1834Research ArticleОБЗОРЫ И КРАТКИЕ СООБЩЕНИЯREVIEWS & SHORT COMMUNICATIONSЗаболевания печени и гемостаз (обзор) Часть II. Холестатические заболевания печени и гемостазLiver Disease and Hemostasis (Review) Part 2. Cholestatic Liver Disease and HemostasisРешетнякВ. И.ReshetnyakVasiliy I.

127473, г. Москва, ул. Делегатская, д. 20, стр. 1

20 Delegatskaya Str., Build 1, 127473 Moscow

vasiliy.reshetnyak@yandex.ruМаевИ. В.MaevIgor V.

127473, г. Москва, ул. Делегатская, д. 20, стр. 1

20 Delegatskaya Str., Build 1, 127473 Moscow

РешетнякТ. М.ReshetnyakTatiana M.

115522, г. Москва, Каширское шоссе, д. 34А

34A Kashirskoye highway, Moscow 115522

ЖуравельС. В.ZhuravelSergei V.

129090, г. Москва, Большая Сухаревская пл., д. 3

3 Bolshaya Sukharevskaya Square, Moscow 129090

ПисаревВ. М.PisarevVladimir M.

107031, г. Москва, ул. Петровка, д. 25, стр. 2

25 Petrovka Str., Build. 2, 107031 Moscow

Московский государственный медико-стоматологический университет им. А. И. Евдокимова Минздрава РоссииРоссияA. I. Evdokimov Moscow State University of medicine and dentistry, Ministry of Health of RussiaRussian FederationНИИ ревматологии им. В. А. НасоновойРоссияV. A. Nasonova Research Institute of RheumatologyRussian FederationНИИ скорой помощи им. Н. В. Склифосовского ДЗМРоссияN. V. Sklifosovsky Research Institute of Emergency Care, Moscow Healthcare DepartmentRussian FederationНИИ общей реаниматологии им. В. А. Неговского ФНКЦ РРРоссияV. A. Negovsky Research Institute of General Reanimatology, Federal Research and Clinical Center of Intensive Care Medicine and RehabilitologyRussian Federation2019241220191568093Copyright © Решетняк В.И., Маев И.В., Решетняк Т.М., Журавель С.В., Писарев В.М., 20192019Решетняк В.И., Маев И.В., Решетняк Т.М., Журавель С.В., Писарев В.М.Reshetnyak V.I., Maev I.V., Reshetnyak T.M., Zhuravel S.V., Pisarev V.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.reanimatology.com/rmt/article/view/1834

Наличие или развитие нарушений функций печени может существенно осложнять течение критических и терминальных состояний. Системные нарушения гемостаза нередко являются ведущими у пациентов реаниматологического профиля с холестатическими заболеваниями печени, поэтому изучение механизмов их развития может внести вклад в понимание развития полиорганной недостаточности при критических состояниях.

В обзоре представлены современные данные об изменениях показателей гемостаза у пациентов с холестатическими заболеваниями печени, предлагается механизм развития таких нарушений, в котором участвуют фосфолипиды мембран тромбоцитов и эндотелиоцитов. Обосновывается предположение о том, что склонность к тромбозам у пациентов с холестатическими заболеваниями печени обусловлена повышенным накоплением желчных кислот в системном кровотоке. Приведены данные о том, что при антифосфолипидном синдроме предрасположенность к образованию тромбов обусловлена изменениями фосфолипидного состава мембран тромбоцитов и эндотелиальных клеток сосудов, возникающими в результате их взаимодействия с циркулирующими антифосфолипидными антителами. Обосновано положение о том, что познание механизмов, лежащих в основе развития изменений в системе свертывания крови при нарушениях функций печени, поможет поиску новых путей обеспечения оптимальной коррекции нарушений гемостаза у пациентов с хроническими заболеваниями печени.

The presence or development of liver disorders can significantly complicate the course of critical illness and terminal conditions. Systemic hemostatic disorders are common in Intensive Care Units patients with cholestatic liver diseases, so the study of the mechanisms of their development can contribute to the understanding of the development of multiorgan failure in critical illness.

The review discusses current data on changes in hemostatic parameters in patients with cholestatic liver diseases, proposes a mechanism for the development of such disorders, which involve interactions of phospholipids with platelet and endotheliocyte membranes. It is suggested that a trend for thrombosis in patients with cholestatic liver disease is due to increased accumulation of bile acids in the systemic circulation. Available data demonstrate that the antiphospholipid syndrome may predispose to the formation of blood clots due to alterations of phospholipid composition of membranes of platelets and vascular endothelial cells by circulating antiphospholipid antibodies. Clarifying the mechanisms contributing to changes of the blood coagulation system parameters in liver disorders will aid to development of optimal correction of hemostatic disorders in patients with chronic liver diseases.

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