ИММУНОПАТОГЕНЕТИЧЕСКИЕ АСПЕКТЫ ИШЕМИЧЕСКОГО ИНСУЛЬТА

Иммунная система играет ключевую роль в патогенезе ишемического инсульта. Ишемическое поражение головного мозга приводит к разрушению клеток и белков внеклеточного матрикса и высвобождению молекул «опасности», которые вызывают быструю активацию врожденного иммунитета и индуцируют реакции адаптивного иммунитета с аутоиммунной направленностью. Клетки врожденного иммунитета ответственны за элиминацию клеточного и внеклеточного детрита и тканевую репарацию, однако также вовлечены в запуск постишемического воспаления, вызывающего повреждение мозговой ткани. Развивающиеся через несколько дней реакции адаптивного иммунитета, направленные против собственных антигенов, не имеют отношения к повреждению нервной ткани в остром периоде. Клетки адаптивного иммунитета способны регулировать активность микроглии и стимулировать процессы восстановления в центральной нервной системе. Тем не менее длительная персистенция сенсибилизированных к мозгоспецифическим антигенам лимфоцитов может быть причастна к атрофии коры головного мозга и развитию деменции в отдаленном периоде инсульта. Иммунный ответ на ишемическое поражение мозга имеет как локальные, так и системные проявления. При этом, в отличие от продолжительного интрацеребрального воспаления в зоне инфаркта и окружающих тканях, системный воспалительный ответ на периферии быстро сменяется развитием иммуносупрессии, что подтверждается лимфопенией, атрофией лимфоидных органов и дефектом функциональной активности иммунных клеток. Иммуносупрессия во многом обусловлена активацией симпатоадреналовой системы и направлена на ограничение воспаления и аутоиммунных реакций. Тем не менее, избыточные проявления иммуносупрессии приводят к развитию инфекционных осложнений, часто являющихся причиной летального исхода, а также могут негативно сказываться на эффективности репаративных процессов. В настоящем обзоре представлены экспериментальные и клинические данные, характеризующие реакции врожденного и приобретенного иммунитета в ответ на церебральную ишемию. Кроме того, в обзоре обсуждается патогенетическая значимость иммунных клеток и опосредованных ими позитивных и негативных эффектов, осмысление которых позволит разработать новые подходы к лечению ишемического инсульта.

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