medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»10.33667/2078-5631-2023-9-64-69medalphabet-3141Research ArticleСтатьиВлияние воспаления на липидный профиль при хронических ревматических заболеванияхInfluence of inflammation on lipid profile in chronic rheumatic diseasesШиловаЛ. Н.ShilovaL. N.

Шилова Людмила Николаевна, д. м. н., доцент, зав. кафедрой госпитальной терапии, ВПТ

Волгоград

Shilova Lyudmila N., DM Sci (habil.), associate professor at Dept of Hospital Therapy, MFT

Volgograd

ludshilova@mail.ruhttps://orcid.org/0000-0001-5127-611XСпицинаС. С.SpitsinaS. S.

Спицина Светлана Сергеевна, ассистент кафедры госпитальной терапии, ВПТ, м. н. с., ФГБНУ «Научно-исследовательский институт клинической и экспериментальной ревматологии имени А. Б. Зборовского»

Волгоград

Spitsina Svetlana S., assistant at Dept of Hospital Therapy, MFT, Volgograd State Medical University; junior researcher, Research Institute for Clinical and Experimental Rheumatology n. a. A. B. Zborovsky

Volgograd

ssspitsina@mail.ruФГБОУ ВО «Волгоградский государственный медицинский университет» Минздрава РоссииРоссияVolgograd State Medical UniversityRussian FederationФГБОУ ВО «Волгоградский государственный медицинский университет» Минздрава России; ФГБНУ «Научно-исследовательский институт клинической и экспериментальной ревматологии имени А. Б. Зборовского»РоссияVolgograd State Medical University; Research Institute for Clinical and Experimental Rheumatology n. a. A. B. ZborovskyRussian Federation20232306202309Ревматология в общей врачебной практике (1)6469Copyright © Шилова Л.Н., Спицина С.С., 20232023Шилова Л.Н., Спицина С.С.Shilova L.N., Spitsina S.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-alphabet.com/jour/article/view/3141

Хронические воспалительные ревматические заболевания связаны с повышенным риском сердечно-сосудистой патологии. У пациентов данной группы воспаление вызывает различные изменения в метаболизме липидов, которые при хроническом течении могут способствовать повышенному риску атеросклероза. Наиболее часто регистрируются снижение уровня холестерина липопротеинов высокой плотности (ХСЛПВП) в сыворотке крови и увеличение уровня триглицеридов (ТГ). Повышение последних обусловлено как усиленной продукцией и секрецией холестерина липопротеинов очень низкой плотности (ХС-ЛПОНП) в печени, так и снижением клиренса липопротеинов, богатых ТГ. Механизмы, лежащие в основе воздействия иммунного воспаления на уровень ХС-ЛПВП, остаются недостаточно ясными. Наряду с этим при рассматриваемых заболеваниях наблюдается стойкое увеличение липопротеина (а) (Лп[а]) из-за его повышенного синтеза. Системное воспаление отрицательно влияет на метаболизм липопротеинов: ХС-ЛПНП легче окисляется из-за снижения способности ХС-ЛПВП предотвращать это окисление. Более того, хроническое воспаление неблагоприятно влияет на механизм обратного транспорта холестерина. При этом имеется ассоциация между тяжестью основного заболевания и выраженностью указанных нарушений липидного метаболизма. В целом подходы к коррекции липидного обмена у пациентов с воспалительными ревматическими заболеваниями аналогичны тем рекомендациям, которые применяются в общей популяции.

Chronic inflammatory rheumatic diseases are associated with an increased risk of cardiovascular disease. In this group of patients, inflammation causes various changes in lipid metabolism, which in a chronic course may contribute to an increased risk of atherosclerosis. The most frequent abnormality is decreased serum high-density lipoprotein cholesterol (HDL–C) and increased triglyceride (TG) levels. This imbalance may be due to increased production and secretion of very low-density lipoprotein cholesterol (VLDL–С) in the liver and decreased clearance of TG-rich lipoproteins. The mechanisms by which inflammation lowers HDL–C levels are still unclear. Additionally, there is a persistent increase in lipoprotein (a) (Lp[a]) due to its increased synthesis. Thus, systemic inflammation negatively affects lipoprotein function: LDL–C oxidation becomes more active since there is the decreased ability of HDL–C to prevent this pathway. Moreover, chronic inflammation adversely affects the reverse cholesterol transport mechanism. The greater the severity of the underlying disease is associated with the more pronounced disorders in lipid metabolism. In general, approaches to the correction of lipid metabolism in patients with inflammatory rheumatic diseases are similar to those in patients from the general population.

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