Междисциплинарный подход к проблеме желчнокаменной болезни у женщин: взгляд гинеколога
Междисциплинарный подход к проблеме желчнокаменной болезни у женщин: взгляд гинеколога
Успенская Ю.Б., Кузнецова И.В., Шептулин А.А. Междисциплинарный подход к проблеме желчнокаменной болезни у женщин: взгляд гинеколога. Гинекология. 2020; 22 (2): 41–45.
DOI: 10.26442/20795696.2020.2.200145
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Uspenskaya Yu.B., Kuznetsova I.V., Sheptulin A.A. An interdisciplinary approach to the problem of gallstone disease in women: a view of a gynecologist. Gynecology. 2020; 22 (2): 41–45. DOI: 10.26442/20795696.2020.2.200145
Междисциплинарный подход к проблеме желчнокаменной болезни у женщин: взгляд гинеколога
Успенская Ю.Б., Кузнецова И.В., Шептулин А.А. Междисциплинарный подход к проблеме желчнокаменной болезни у женщин: взгляд гинеколога. Гинекология. 2020; 22 (2): 41–45.
DOI: 10.26442/20795696.2020.2.200145
________________________________________________
Uspenskaya Yu.B., Kuznetsova I.V., Sheptulin A.A. An interdisciplinary approach to the problem of gallstone disease in women: a view of a gynecologist. Gynecology. 2020; 22 (2): 41–45. DOI: 10.26442/20795696.2020.2.200145
В статье обсуждаются современные представления о патогенетических механизмах развития желчнокаменной болезни (ЖКБ) у женщин, проиллюстрированные клиническими наблюдениями. Гендер-ассоциированными факторами риска ЖКБ являются беременности и роды, применение препаратов женских половых гормонов и синдром поликистозных яичников. Факторами, способствующими развитию ЖКБ у женщин, принимающих гормональные комбинированные оральные контрацептивы и менопаузальную гормональную терапию, являются наследственная предрасположенность, нарушения липидного и углеводного обмена, функциональные расстройства желчного пузыря. Пациенткам высокого риска развития ЖКБ рекомендуется проводить ультразвуковое исследование с целью контроля состояния желчного пузыря до начала гормональной терапии и на ее протяжении. При выявлении билиарного сладжа безопасным и эффективным является назначение лечебных и профилактических курсов урсодезоксихолевой кислоты. Ключевые слова: синдром поликистозных яичников, билиарный сладж, комбинированные оральные контрацептивы, менопаузальная гормональная терапия, менопауза, холелитиаз, урсодезоксихолевая кислота.
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The article presents the modern view on pathogenetic mechanisms of the cholelithiasis development in women, illustrated by clinical observations. Gender-associated risk factors for cholelithiasis are pregnancy and childbirth, female sex hormones administration and polycystic ovary syndrome. The gallstone disease risk factors in women taking hormonal oral contraceptives and menopausal hormone therapy are hereditary predisposition, impaired lipid, carbohydrate metabolism and functional gallbladder disorders. Patients at high risk of developing cholelithiasis are recommended to perform a gallbladder ultrasound examination before and during hormonal therapy. The ursodeoxycholic acid treatment is safe, effective and compatible with female sex hormone administration in patients with detected biliary sludge.
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19. Duan LP, Wang HH, Ohashi A, Wang DQ. Role of intestinal sterol transporters Abcg5, Abcg8, and Npc1l1 in cholesterol absorption in mice: gender and age effects. Am J Physiol Gastrointest Liver Physiol 2006; 290 (2): G269–G276. DOI: 10.1152/ajpgi.00172.2005
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28. Isik S, Ozcan HN, Ozuguz U et al. Impaired gallbladder motility and the effect of metformin therapy in patients with polycystic ovary syndrome. Clin Endocrinol (Oxf) 2012; 76 (3): 373–8. DOI: 10.1111/j.1365-2265.2011.04210.x.
29. Kline LW, Karpinski E. Testosterone and dihydrotestosterone inhibit gallbladder motility through multiple signaling pathways. Steroids 2008; 73: 1174–80.
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[Ivanchenkova R.A. Chronic diseases of the biliary tract. Moscow: Atmosfera, 2006 (in Russian).]
32. Sieron D, Czerny B, Sieron-Stoltny K et al. The effect of chronic estrogen application on bile and gallstone composition in women with cholelithiasis. Minerva Endocrinol 2016; 41 (1): 19–27.
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p. 201–9.
________________________________________________
1. Strom BL, Tamragouri RN, Morse ML et al. Oral contraceptives and other risk factors for gallbladder disease. Clin Pharmacol Ther 1986; 39: 335–41.
2. Burkov S. G. O posledstviiakh kholetsistektomii ili postkholetsistektomicheskom sindrome. Gastroenterology (Suppl. Consilium Medicum). 2004; 6 (2): 24–7 (in Russian).
3. Burkov S. G., Grebenev A. L. Gallstone disease (epidemiology, pathogenesis, clinic). Guide to gastroenterology. In three volumes. Ed. F.I. Komarova, A.L. Grebeneva. V. 2. Diseases of the liver and biliary system. Moscow: Meditsina, 1995; s. 417–41 (in Russian).
4. Vikhrova T.V. Biliarnyi sladzh i ego klinicheskoe znachenie. Dis. kand. med. nauk. Moscow, 2003 (in Russian).
5. Grigor'eva I.N., Romanova T.I. Osnovnye faktory riska i kachestvo zhizni u bol'nykh zhelchnokamennoi bolezn'iu. Eksperim. i klin. gastroenterologiia. 2011; 4: 21–5 (in Russian).
6. Lazebnik L.B., Kopaneva, I.M., Ezhova T. B. Need for medical care after surgery on the stomach and gall blad-der (Review of references and own observations). Therapeutic Archive. 2004; 2: 83–7. (in Russian).
7. Acalovschi M. Cholesterol gallstones: from epidemiology to prevention. Postgrad Med J 2001; 77: 221–9.
8. Koebnick C, Smith N, Black MH et al. Pediatric obesity and gallstone disease. J Pediatr Gastroenterol Nutr 2012; 55 (3): 328–33. DOI: 10.1097/MPG.0b013e31824d256f
9. European Association for the Study of the Liver (EASL). Electronic address: easloffice@easloffice.eu. EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones. J Hepatol 2016; 65 (1): 146–81. DOI: 10.1016/j.jhep.2016.03.005
10. Boston Collaborative Drug Surveillance Programme. Oral contraceptives and venous thromboembolic disease, surgically confirmed gallbladder disease, and breast tumours. Lancet 1973; 1: 1399–404.
11. Cirillo DJ, Wallace RB, Rodabough RJ et al. Effect of estrogen therapy on gallbladder disease. JAMA 2005; 293: 330–9.
12. De Bari O, Wang TY, Liu M et al. Cholesterol cholelithiasis in pregnant women: pathogenesis, prevention and treatment. Ann Hepatol 2014; 13 (6): 728–45.
13. Maringhini A, Ciambra M, Baccelliere P et al. Biliary sludge and gallstones in pregnancy: incidence, risk factors, and natural history. Ann Intern Med 1993; 119: 116–20.
14. Honore LH. Increased incidence of symptomatic cholesterol cholelithiasis in perimenopausal women receiving estro- gen replacement therapy: a retrospective study. J Reprod Med 1980; 25: 187–90.
15. Attili AF, De Santis A, Capri R et al. The natural history of gallstones: the GREPCO experience. The GREPCO Group. Hepatology 1995; 21: 655–60.
16. Leishner U. A Practical Guide to Biliary Diseases. Moscow: GEOTAR-Med, 2001. (in Russian).
17. Il'chenko A.A. Cholelithiasis. Moscow: Anakharsis, 2004 (in Russian).
18. Caruso MG, Giangrande M, Clemente C et al. Lipidi sierici e sabbia biliare durante la gravidanza [Serum lipids and biliary sludge during pregnancy]. Minerva Gastroenterol Dietol 1993; 39 (2): 67–70.
19. Duan LP, Wang HH, Ohashi A, Wang DQ. Role of intestinal sterol transporters Abcg5, Abcg8, and Npc1l1 in cholesterol absorption in mice: gender and age effects. Am J Physiol Gastrointest Liver Physiol 2006; 290 (2): G269–G276. DOI: 10.1152/ajpgi.00172.2005
20. Liu B, Beral V, Balkwill A et al. Gallbladder disease and use of transdermal versus oral hormone replacement therapy in postmenopausal women: prospective cohort study. BMJ 2008; 337: a386. DOI: 10.1136/bmj.a386
21. Shaffer EA. Epidemiology and risk factors for gallstone disease: has the paradigm changed in the 21st century? Curr Gastroenterol Rep 2005; 7: 132–40.
22. Ko CW, Beresford SA, Schulte SJ et al. Incidence, natural history, and risk factors for biliary sludge and stones during pregnancy. Hepatology 2005; 41: 359–65.
23. Philipp BW, Shapiro DJ. Estrogen regulation of hepatic 3-hydroxy-3-methylglutaryl coenzyme A reductase and acetyl-CoA carboxylase in xenopus laevis. J Biol Chem 1981; 256 (6): 2922–7.
24. Reproductive Medicine Guide. Pod red. B. Karra, R. Blekuella, R. Aziza. Per. s angl. Moscow: Praktika, 2015 (in Russian).
25. El-Mazny A, Abou-Salem N, El-Sherbiny W, El-Mazny A. Insulin resistance, dyslipidemia, and metabolic syndrome in women with polycystic ovary syndrome. Int J Gynaecol Obstet 2010; 109: 239–41.
26. Valdivieso V, Covarrubias C, Siegel F, Cruz F. Pregnancy and cholelithiasis: pathogenesis and natural course of gallstones diagnosed in early puerperium. Hepatology 1993; 17: 1–4.
27. Ness GC, Chambers CM. Feedback and hormonal regulation of hepatic 3-hydroxy-3-methylglutaryl coenzyme A reductase: the concept of cholesterol buffering capacity. Proc Soc Exp Biol Med 2000; 224 (1): 8–19.
28. Isik S, Ozcan HN, Ozuguz U et al. Impaired gallbladder motility and the effect of metformin therapy in patients with polycystic ovary syndrome. Clin Endocrinol (Oxf) 2012; 76 (3): 373–8. DOI: 10.1111/j.1365-2265.2011.04210.x.
29. Kline LW, Karpinski E. Testosterone and dihydrotestosterone inhibit gallbladder motility through multiple signaling pathways. Steroids 2008; 73: 1174–80.
30. Barber TM, McCarthy MI, Wass JA, Franks S. Obesity and polycystic ovary syndrome. Clin Endocrinol (Oxf) 2006; 65 (2): 137–45.
31. Ivanchenkova R.A. Chronic diseases of the biliary tract. Moscow: Atmosfera, 2006 (in Russian).
32. Sieron D, Czerny B, Sieron-Stoltny K et al. The effect of chronic estrogen application on bile and gallstone composition in women with cholelithiasis. Minerva Endocrinol 2016; 41 (1): 19–27.
33. Racine A, Bijon A, Fournier A et al. Menopausal hormone therapy and risk of cholecystectomy: a prospective study based on the French E3N cohort. CMAJ 2013; 185 (7): 555–61. DOI: 10.1503/cmaj.121490
34. Wild RA. The PCO paradigm: sex steroids, lipoprotein lipids, clotting, and the arterial wall. In The Ovary: Regulation, Dysfunction and Treatment. M Filicori and C Flamigni, eds. Elsevier Science B.V., 1996;
p. 201–9.
Авторы
Ю.Б. Успенская*1, И.В. Кузнецова2, А.А. Шептулин3
1 Клиника «Андреевские больницы – НЕБОЛИТ», Москва, Россия;
2 НОЧУ ДПО «Высшая медицинская школа», Москва, Россия;
3 ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
*jusp@mail.ru
________________________________________________
Yulia B. Uspenskaya*1, Irina V. Kuznetsova2, Arkadiy A. Sheptulin3
1 Andreevsky hospitals – NEBOLIT, Moscow, Russia;
2 Higher Medical School, Moscow, Russia;
3 Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
*jusp@mail.ru