Влияние терапии генно-инженерными биологическими препаратами на систему гемостаза у пациентов с ревматоидным артритом

Пациенты с ревматоидным артритом (РА) имеют повышенный риск развития атеросклероза. Существенный вклад в прогрессирование атеросклеротического поражения артерий у больных РА вносят активация системы гемостаза и системное воспаление. Генно-инженерные биологические препараты (ГИБП) все чаще применяются у пациентов с РА. Учитывая наличие взаимосвязи между системным воспалением и гемостатическими нарушениями, не лишено оснований предположение о том, что ГИБП могут оказывать влияние на систему гемостаза у больных РА. Цель исследования – на основе анализа данных научных исследований продемонстрировать влияние генно-инженерной биологической терапии на систему гемостаза, а также оценить связь между системным воспалением и гиперкоагуляцией у пациентов с РА.

Материал и методы. Поиск публикаций проводился в научных базах данных Scopus, Web of Sciences, PubMed, The Cochrane Library, eLibrary. В качестве маркеров поиска использовались следующие ключевые слова и словосочетания: ревматоидный артрит (rheumatoid arthritis), атеросклероз (atherosclerosis), гемостаз (hemostasis), тромбоз (thrombosis), противоревматическая терапия (antirheumatic therapy), цитокины (cytokines), системное воспаление (systemic inflammation). Глубина поиска – 2014–2024 гг.

Результаты и их обсуждение. Благоприятное влияние ГИБП на снижение протромбогенного потенциала у больных РА связано со снижением выраженности системного воспаления, модификацией цитокинового статуса, улучшением функции эндотелия. Имеются данные, свидетельствующие о негативном влиянии ГИБП на систему гемостаза у пациентов с РА, что выражается в увеличении риска возникновения венозных и артериальных тромбозов и развития кровотечений.

Заключение. Изучение влияния ГИБП на свертывающую систему крови, а также уточнение патогенетических взаимосвязей между патологией гемостаза и системным воспалением у пациентов с РА представляет значительный научный интерес с точки зрения как снижения риска развития сердечно-сосудистых заболеваний, профилактики тромбоэмболических осложнений, так и поиска новых терапевтических мишеней.

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