НЕВРОЛОГИЧЕСКИЕ ПРОЯВЛЕНИЯ ПЕРВИЧНЫХ ХОЛЕСТАТИЧЕСКИХ БОЛЕЗНЕЙ ПЕЧЕНИ


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Аннотация

Характерные и довольно ранние проявления первичных холестатических болезней печени - кожный зуд, отчётливо выраженный астенический синдром и вегетативные нарушения. Эти симптомы значительно снижают качество жизни больных. Имеющиеся данные свидетельствуют о том, что происхождение кожного зуда и астении при холестатических болезнях печени связано с поражением центральной нервной системы (ЦНС). Разработаны шкалы для оценки выраженности астении, кожного зуда и качества жизни при первичном билиарном холангите. Нарушения памяти и способности к концентрации внимания выявляются также довольно часто, ещё до стадии цирроза печени; они не имеют чёткой связи с биохимическими и гистологическими показателями тяжести поражения печени и склонны к прогрессированию. Некоторые исследователи подчёркивают взаимосвязь астении и когнитивных нарушений с расстройствами автономной (вегетативной) регуляции, систолической гипотензией и нарушением перфузии головного мозга. Происхождение зуда при холестатических болезнях печени в значительной степени связывают с центральной ноцицептивной сенситизацией и повышением тонуса эндогенной опиатной системы. Патогенетические механизмы поражения ЦНС ещё на доцирротической стадии холестатических болезней могут включать нейровоспаление, дефицит витаминов D и E, влияние вторичного гиперпаратиреоза и повышенного содержания жёлчных кислот в крови.

Об авторах

Юлия Олеговна Шульпекова

ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова (Сеченовский университет)

Email: jshulpekova@gmail.com
канд. мед. наук, доцент каф. пропедевтики внутренних болезней лечебного факультета «Первый Московский медицинский университет им. И.М. Сеченова (Сеченовский университет)», 119991, г. Москва 119991, г. Москва

Е. Н Широкова

ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова (Сеченовский университет)

119991, г. Москва

В. Ю Русяев

ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова (Сеченовский университет)

119991, г. Москва

И. В Дамулин

ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова (Сеченовский университет)

119991, г. Москва

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