Тромботическая микроангиопатия в ревматологии: связь тромбовоспаления и аутоиммунитета - Журнал Терапевтический архив №5 Вопросы ревматологии 2020
Тромботическая микроангиопатия в ревматологии: связь тромбовоспаления и аутоиммунитета
Насонов Е.Л., Решетняк Т.М., Алекберова З.С. Тромботическая микроангиопатия в ревматологии: связь тромбовоспаления и аутоиммунитета. Терапевтический архив. 2020; 92 (5): 4–14. DOI: 10.26442/00403660.2020.05.000697
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Аннотация
Неконтролируемые гиперкоагуляция и воспаление («тромбовоспаление» – thromboinflammation), представляющие собой независимые, но тесно связанные и амплифицирующие друг друга патологические процессы, составляют основу патогенеза широкого спектра заболеваний и осложнений, в том числе при иммуновоспалительных (аутоиммунных) ревматических заболеваниях, с развитием потенциально смертельных повреждений внутренних органов. Одним из ярких прототипов «тромбовоспалительных» патологических состояний является тромботическая микроангиопатия. Существование тесной взаимосвязи между факторами внешней среды, генетическими дефектами свертывания крови и компонентов комплемента, воспалением и аутоиммунитетом в качестве патогенетических механизмов микротромбоза привлекает особое внимание к изучению тромботической микроангиопатии при иммуновоспалительных ревматических заболеваниях, в первую очередь системной красной волчанке, антифосфолипидном синдроме и склеродермическом почечном кризе. Эти исследования в перспективе могут иметь значение для расширения представлений о роли аутоиммунных механизмов патогенеза «критических» нарушений гемостаза при заболеваниях человека, разработки новых подходов к терапии. В последнее время привлечено внимание к применению для лечения системной красной волчанки и антифосфолипидного синдрома препарата экулизумаб, представляющего собой гуманизированные моноклональные IgG2/4k-антитела, блокирующие С5а-компонент комплемента и образование мембраноатакующего комплекса (С5b-9). Препарат зарегистрирован для лечения атипичного гемолитико-уремического синдрома, пароксизмальной ночной гемоглобинурии, а также тяжелых форм миастении и оптического нейромиелита. Дальнейшие исследования в этом направлении создадут предпосылки для улучшения прогноза не только у пациентов с орфанной патологией, но и широко распространенными заболеваниями человека.
Ключевые слова: тромботическая микроангиопатия, системная красная волчанка, антифосфолипидный синдром, экулизумаб.
Keywords: thrombotic microangiopathy, systemic lupus erythematosus, antiphospholipid syndrome, eculizumab.
Ключевые слова: тромботическая микроангиопатия, системная красная волчанка, антифосфолипидный синдром, экулизумаб.
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Keywords: thrombotic microangiopathy, systemic lupus erythematosus, antiphospholipid syndrome, eculizumab.
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3. Chanchal S, Mishra A, Singh MK, Ashraf MZ. Understanding Inflammatory Responses in the Manifestation of Prothrombotic Phenotypes. Front Cell Dev Biol. 2020;8:73. doi: 10.3389/fcell.2020.00073
4. Margetic S. Inflammation and haemostasis. Biochem Med. 2012;22:49-62. doi: 10.11613/BM.2012.006
5. Babar F, Cohen SD. Thrombotic Microangiopathies with Rheumatologic Involvement. Rheum Dis Clin North Am. 2018 Nov;44(4):635-49. doi: 10.1016/j.rdc.2018.06.010
6. George JN, Nester CM. Syndromes of thrombotic microangiopathy.
N Engl J Med. 2014;371:654-66. doi:10.1056/NEJMoa1410490
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20. Dijkstra DJ, Joeloemsingh JV, Bajema IM, Trouw LA. Complement activation and regulation in rheumatic disease. Semin Immunol. 2019;45:101339. doi: 10.1016/j.smim.2019.101339
21. Thurman JM, Yapa R. Complement Therapeutics in Autoimmune
Disease. Front Immunol. 2019;10:672. doi: 10.3389/fimmu.2019.
00672
22. Kaul A, Gordon C, Crow MK, et al. Systemic lupus erythematosus. Nat Rev Dis Primers. 2016;2:16039. doi: 10.1038/nrdp.2016.39
23. Насонов Е.Л. Системная красная волчанка. В кн.: Российские клинические рекомендации. 2017. М.: ГЭОТАР-Медиа, 2017; с. 113-41 [Nasonov EL. Systemic lupus erythematosus. In: Russian Kliscientific recommendations. 2017. Moscow: GEOTAR-Media, 2017; p. 113-41 (In Russ.)].
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25. Yue C, Su J, Gao R, et al. Characteristics and Outcomes of Patients with Systemic Lupus Erythematosus-associated Thrombotic Microangiopathy, and Their Acquired ADAMTS13 Inhibitor Profiles. J Rheumatol. 2018;45(11):1549-56. doi: 10.3899/jrheum.170811
26. Kello N, Khoury LE, Marder G, et al. Secondary thrombotic microangiopathy in systemic lupus erythematosus and antiphospholipid syndrome, the role of complement and use of eculizumab: Case series and review of literature. Semin Arthritis Rheum. 2019;49(1):74-83. doi: 10.1016/j.semarthrit.2018.11.005
27. Hess DC, Sethi K, Awad E. Thrombotic thrombocytopenic purpura in systemic lupus erythematosus and antiphospholipid antibodies: effective treatment with plasma exchange and immunosuppression. J Rheumatol. 1992;19:1474-8. PMid: 1433020.
28. Durand JM, Lefevre P, Kaplanski G, Soubeyrand J. Thrombotic microangiopathy and the antiphospholipid antibody syndrome. J Rheumatol. 1991;18:1916-8. PMid: 1795331.
29. Tulai IM, Penciu OM, Raut R, Rudinskaya A. Catastrophic Antiphospholipid Syndrome Presenting as Congestive Heart Failure in a Patient with Thrombotic Microangiopathy. Tex Heart Inst J. 2019;46(1):48-52. doi: 10.14503/THIJ-17-6472
30. Sciascia S, Cuadrado MJ, Khamashta M, et al. Renal involvement in antiphospholipid syndrome. Nat Rev Nephrol. 2014;10:279-89.
doi: 10.1038/nrneph.2014.38
31. Tsuchimoto A, Matsukuma Y, Ueki K, et al. Thrombotic microangiopathy associated with anticardiolipin antibody in a kidney transplant recipient with polycythemia. CEN Case Rep. 2019;8(1):1-7.
doi: 10.1007/s13730-018-0354-x
32. Zhou XJ, Chen M, Wang SX, et al. A 3-year follow-up of a patient with acute renal failure caused by thrombotic microangiopathy related to antiphospholipid syndrome: case report. Lupus. 2017;26(7):777-82.
doi: 10.1177/0961203316682098
33. Espinosa G, Bucciarelli S, Cervera R, et al. Thrombotic microangiopathic haemolytic anaemia and antiphospholipid antibodies. Ann Rheum Dis. 2004;63:730-6. doi: 10.1136/ard.2003.007245
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Авторы
Е.Л. Насонов1,2, Т.М. Решетняк1,3, З.С. Алекберова1
1 ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой», Москва, Россия;
2 ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия;
3 ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия
1 Nasonova Research Institute of Rheumatology, Moscow, Russia;
2 Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia;
3 Russian Medical Academy of Continuous Professional Education, Moscow, Russia
1 ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой», Москва, Россия;
2 ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия;
3 ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия
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1 Nasonova Research Institute of Rheumatology, Moscow, Russia;
2 Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia;
3 Russian Medical Academy of Continuous Professional Education, Moscow, Russia
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