mimmunМедицинская иммунологияMedical Immunology (Russia)1563-06252313-741XSPb RAACI10.15789/1563-0625-MEA-2395mimmun-2395Research ArticleОБЗОРЫREVIEWSСовременные аспекты этиологии и патогенеза хронического периферического увеитаModern etiological and pathogenetic aspects of chronic peripheral uveitishttps://orcid.org/0000-0003-3038-8117ТатарниковаЕ. Б.TatarnikovaE. B.

Аспирант кафедры офтальмологии

634050, г. Томск, Московский тракт, 2

Тел.: 8 (913) 081-27-07

Postgraduate Student, Department of Ophthalmology

634050, Tomsk, Moskovsky Road, 2

Phone: 7 (913) 081-27-07

elenka.morozova.92@inbox.ruКривошеинаО. И.KrivosheinaO. I.

Д.м.н., профессор, заведующая кафедрой офтальмологии

г. Томск

PhD, MD (Medicine), Professor, Head, Department of Ophthalmology

Tomsk

ИвановаЕ. В.IvanovaE. V.

Ассистент кафедры офтальмологии

г. Томск

Assistant Professor, Department of Ophthalmology

Tomsk

ФГБОУ ВО «Сибирский государственный медицинский университет» Министерства здравоохранения РФРоссияSiberian State Medical UniversityRussian Federation2022100320222413140Copyright © Татарникова Е.Б., Кривошеина О.И., Иванова Е.В., 20222022Татарникова Е.Б., Кривошеина О.И., Иванова Е.В.Tatarnikova E.B., Krivosheina O.I., Ivanova E.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.mimmun.ru/mimmun/article/view/2395

Периферический увеит является одним из наиболее тяжелых эндогенных увеитов, который развивается чаще у лиц молодого возраста и характеризуется скудными клиническими проявлениями на ранних стадиях развития. Значительное и зачастую необратимое снижение остроты зрения связано с развитием отдаленных осложнений хронического периферического увеита (ХПУ) – осложненной катарактой (частота развития до 57%), кистозным макулярным отеком (частота развития до 31%), офтальмогипертензией и глаукомой (частота развития до 16%). Показатель заболеваемости ХПУ составляет 1,5 на 100 000 в год. Несмотря на высокую иммунную привилегированность, глаз подвержен инфекционным и воспалительным заболеваниям. Клинические и гистопатологические данные указывают на аутоиммунное происхождение ХПУ, связанное с возможной реакцией на эндогенный антиген неизвестного происхождения. Основными эффекторами воспаления периферических хориоретинальных структур являются CD4+Т-лимфоциты, обнаруживающиеся при ХПУ в паравазальных инфильтратах и витреоретинальных экссудатах. Важная роль в патогенезе заболевания отводится интерлейкинам IL-6 и IL-8, фактору некроза опухоли á – TNFá, сосудистому эндотелиальному фактору роста – VEGF и микрорибонуклеиновой кислоты, повышенная экспрессия которых обнаруживается у большинства больных ХПУ. Одним из потенциальных триггеров внутриглазного воспаления является нарушения состояния бактериального микробиома кишечника. Выявлена также генетическая предрасположенность к ХПУ, обусловленная лейкоцитарным антигеном человека и некоторыми другими генами. Для разработки эффективного фармакологического лечения ХПУ необходимо расширять и углублять знания о патогенезе данного заболевания. Статья представляет собой литературный обзор современных научных представлений об этиологии и механизмах развития ХПУ.

Intermediate uveitis is among most severe forms of endogenous uveitis which is more common in young people, being characterized by minimal clinical manifestations at early stages of the disorder. A significant and, sometimes, irreversible decrease in visual acuity is associated with development of long-term complications of chronic cintermediate uveitis (CIU), i.e., complicating cataracts (in up to 57% of the cases), cystic maular edema developing at a frequency of up to 31%), as well as ophthalmic hypertension and glaucoma (up to 16% of the patients). The incidence rate of CIU is 1.5 per 100,000 per year. The eye, despite its high immune privilege, is susceptible to infectious and inflammatory diseases. Clinical and histopathological data suggest autoimmune origin of CIU associated with possible response to some endogenous antigen of unknown origin. The main effectors of inflammation in peripheral chorioretinal structures are CD4+T lymphocytes, which are found in paravasal infiltrates and vitreoretinal exudates in CIU. An important role in CIU pathogenesis is attributed to IL-6 and IL-8, TNFá, vascular endothelial growth factor (VEGF), and micro-RNAs, which show increased expression in most CIU patients. Impaired state of intestinal bacterial microbiome is a potential trigger of intraocular inflammation. Genetic predisposition for CIU was also revealed, due to polymorphisms of human leukocyte antigens and some other genes. It is necessary to expand and deepen our knowledge on the disease pathogenesis, in order to develop effective pharmacological treatment of CIU. The article is review of literature discussing the modern scientific ideas concerning etiology and mechanisms of the CIU development.

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