bmjourБайкальский медицинский журналBaikal Medical Journal2949-0715Irkutsk State Medical University10.57256/2949-0715-2023-4-33-45bmjour-170Research ArticleНаучные обзоры литературыScientific literature reviewsГИПОХОЛЕСТЕРОЛЕМИИ ПРИ СЕПТИЧЕСКИХ СОСТОЯНИЯХ. МЕХАНИЗМЫ РАЗВИТИЯ И ПУТИ КОРРЕКЦИИHYPOCHOLESTEROLEMIA IN SEPTIC CONDITIONS. MECHANISMS OF DEVELOPMENT AND WAYS OF CORRECTIONhttps://orcid.org/0009-0002-7522-2225ГригорьеваКаролина РуслановнаGrigor’evaKarolina R.karolina_grigoreva@inbox.ruhttps://orcid.org/0000-0003-2074-3832ОсочукСергей СтефановичOsochukSergey S.oss62@mail.ruhttps://orcid.org/0000-0001-6069-4102ОсочукВиктор СтефановичOsochukViktor S.vosochuk@gmail.comВитебский государственный ордена Дружбы народов медицинский университетБеларусьVitebsk Order of Friendship of Peoples Medical UniversityBelarusВитебский ордена Дружбы народов медицинский университетБеларусьVitebsk Order of Friendship of Peoples Medical UniversityBelarusПинская Центральная больницаБеларусьVitebsk Order of Friendship of Peoples Medical UniversityBelarus202325122023243345Copyright © Григорьева К.Р., Осочук С.С., Осочук В.С., 20232023Григорьева К.Р., Осочук С.С., Осочук В.С.Grigor’eva K., Osochuk S., Osochuk V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.bmjour.ru/jour/article/view/170

Одной из существенных проблем медицины на протяжении многих десятилетий является сепсис, который характеризуется высокими уровнями заболеваемости, летальности и большими финансовыми затратами. Обзор посвящен клеточным и молекулярно-биологическим механизмам сепсиса, включающим иммунные, биохимические изменения, митохондриальные трансформации, коагулопатию, нейроэндокринные нарушения, повреждения эндоплазматического ретикулума и ряд других процессов, в конечном итоге приводящих к полиорганной недостаточности. Представлено 2 направления развития клеточных и молекулярно-биологических изменений при генерализованном воспалении, заканчивающиеся благоприятным или неблагоприятным исходом. Суммирована информация об изменениях транспорта холестерола и полиненасыщенных жирных кислот в тканях на фоне септических процессов. Подробно рассматриваются механизмы снижения концентрации холестерола в тканях, влияние гипохолестеролемии на течение генерализованного воспалительного процесса и развитие такого осложнения, как синдром Уотерхауса-Фридериксена. Сформирована концепция цепи патогенетических изменений, приводящих к летальному исходу, и на её основе рассмотрены изложенные в литературе методы коррекции метаболизма при сепсисе (внутривенное введение восстановленных липопротеинов высокой плотности (ЛПВП), ингибирование пропротеинконвертазы субтилизин кексин 9 (PCSK9)). Впервые предложена концепция терапии септических состояний холестеролом в составе липосом.

Sepsis is one of the significant problems in medicine for many decades. It is characterized by high levels of morbidity, mortality and high financial costs. The review is devoted to the cellular and molecular biological mechanisms of sepsis, including immune, biochemical changes, mitochondrial transformations, coagulopathy, neuroendocrine disorders, damage to the endoplasmic reticulum and a number of other processes that ultimately lead to multiple organ fail-ure. The article presents two directions of development of cellular and molecular biological changes in generalized inflammation, ending with a favorable or unfavorable outcome. Information on changes in the transport of cholesterol and polyunsaturated fatty acids in tissues against the background of septic processes is summarized. The mechanisms of reducing the concentration of cholesterol in tissues, the influence of hypocholesterolemia on the course of a gen-eralized inflammatory process and the development of such complications as Waterhouse – Friderichsen syndrome are discussed in detail. A concept of a chain of pathogenetic changes causing lethal outcome has been formed, and on its basis, methods for correcting metabolism in sepsis described in the literature (intravenous administration of reduced high-density lipoproteins, inhibition of proprotein convertase subtilisin kexin 9) are considered. For the first time, the concept of treating septic conditions with cholesterol in the composition of liposomes was proposed.

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