Mekhanizmy zashchity slizistoy obolochki zheludka i NO-vysvobozhdayushchie nesteroidnye protivovospalitel'nye preparaty


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Abstract

Слизистая оболочка желудка (СОЖ) регулярно подвергается воздействию множества вредоносных субстанций и факторов, имеющих разную температуру и осмолярность, включающих большие объемы продуцируемой соляной кислоты, пепсин, способный вызвать разрушение (переваривание) тканей, лекарства, токсины, содержащиеся в пище, алкоголь, Helicobacter pylori. Однако, несмотря на обилие потенциально вредных факторов, СОЖ сохраняет свою структурную целостность и функциональность [1]. В физиологических условиях целостность СОЖ осуществляется благодаря наличию механизмов защиты, включающих: преэпителиальные факторы (слизе-бикарбонато-фосфолипидный «барьер»); эпителиальные факторы (эпителиальный «барьер»: соединенные плотными межклеточными контактами клетки поверхностного эпителия, генерирующими бикарбонат, слизь, фосфолипиды, пептиды-трилистники, простагландины – ПГ, белки теплового шока); непрерывное клеточное обновление, обеспечиваемое пролиферацией прогениторных клеток (регулируемое факторами роста, ПГЕ2 и факторами, сохраняющими жизнеспособность клеток), непрекращающимся кровоснабжением посредством микрососудов слизистой оболочки, эндотелиальным «барьером», сенсорной иннервацией, генерацией ПГ и оксида азота (NO). Таким образом, защита СОЖ состоит из: а) структурных элементов, предупреждающих проникновение повреждающих факторов внутрь, системы распознавания и эффекторных механизмов, обеспечивающих барьерные свойства; б) механизмов заживления, обеспечивающих быстрое восстановление поврежденных участков. Все эти механизмы имеют многочисленные внутренние связи между собой и координируются посредством множества химических молекул – посредников (мессенджеров). В данном обзоре мы ограничимся рассмотрением роли ПГ и NO в механизмах защиты СОЖ и нестероидных противовоспалительных препаратов (НПВП), высвобождающих NO. Детальное обсуждение всех механизмов защиты СОЖ и двенадцатиперстной кишки (ДПК) сделано в обзорах, опубликованных в рецензируемых журналах

About the authors

V. D Pasechnikov

ГБОУ ВПО Ставропольский государственный медицинский университет Минздрава России

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