Тромбоциты в развитии сепсиса, септического шока и синдрома полиорганной недостаточности

Участие тромбоцитов в развитии сепсиса наглядно иллюстрируют гемокоагуляционные нарушения и часто регистрируемая тромбоцитопения. У больных сепсисом тромбоцитопения развивается быстро, минимальные количества пластинок регистрируются на четвертый день наблюдения, после чего количество тромбоцитов обычно повышается. Длительно регистрируемая тромбоцитопения и отсутствие относительного прироста тромбоцитов определены как предикторы смерти больных. Механизмы развития тромбоцитопении при сепсисе очень разнообразны, но преобладающими являются периферические процессы, так называемое «потребление тромбоцитов», определяемое их активацией, хемотаксисом и изоляцией в микроциркуляторном русле. Недавно выявлен механизм ускоренного удаления из циркуляции тромбоцитов с десиалированнными поверхностными гликопротеинами. Сиалидазы, также известные как нейраминидазы, широко представлены у вирусов и бактерий, причем фармакологическая ингибиция сиалидаз способна противостоять тромбоцитопении при инфекционном процессе. Выявлена ключевая роль тромбоцитов в развитии септического шока. Секвестрация тромбоцитов в микрососудах легких и мозга (которая проявляется как тромбоцитопения) сопровождается быстрым выделением серотонина, который и обеспечивает развитие основных клинических проявления, таких как снижения АД, ЧСС и увеличение проницаемости капилляров. Для противодействия резкому выбросу этого медиатора предпринимаются попытки фармакологически ингибировать транспортер SERT селективными ингибиторами обратного захвата серотонина. Тромбоциты являются ключевыми участниками патогенеза таких проявления синдрома полиорганной недостаточности, как острое почечное повреждение, острый респираторный дистресс-синдром, дисфункция миокарда и сепсис-ассоциированная энцефалопатия. Для восстановления нарушенной сосудистой проницаемости при этих состояниях, особенно сепсис-ассоциированной энцефалопатии, исследуется фармакологический миметик рецепторов S1P. В обзоре обозначены возможные патогенетически значимые мишени, которые могут быть использованы для фармакологической коррекции состояний, связанных с сепсисом и сопутствующей тромбоцитопенией.

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