nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical University10.36485/1561-6274-2024-28-1-13-29BTZUNDnefr-2287Research ArticleОБЗОРЫ И ЛЕКЦИИREVIEWS AND LECTURESДисфункция липопротеинов у больных с хронической болезнью почек (ХБП). Патогенез и лечение ХБП – дислипидемии (обзор литературы)Lipoprotein dysfunction in patients with chronic kidney disease (CKD). Pathogenesis and treatment of CKD dyslipidemia (literature review)https://orcid.org/0009-0001-5725-0241ЕрмоленкоВ. М.ErmolenkoV. M.

Проф. Валентин Михайлович Ермоленко, д-р мед. наук, кафедра нефрологии и гемодиализа,

123242, Москва, ул. Баррикадная, д. 2/1, стр. 1

Prof. Valentin M. Ermolenko Department of Nephrology and Hemodialysis, MD, PhD, DMedSci,

123242, Moscow, 2/1 Barrikadnaya Str., bid. 1

v.m.ermolenko@gmail.comРоссийская медицинская академия непрерывного последипломного образованияРоссияRussian Medical Academy of Continuous Professional EducationRussian Federation2024030320242811329Copyright © Ермоленко В.М., 20242024Ермоленко В.М.Ermolenko V.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephrolog.ru/jour/article/view/2287

Дислипидемия развивается на начальных стадиях хронической болезни почек (ХБП) и усугубляется по мере прогрессирования нефропатии. Основным проявлением дислипидемии является гиперхолестеринемия, особенно при нефротическом синдроме. Однако, при ХПБ 4–5 стадий она сменяется гипертриглицеридемией в сочетании с повышением в крови уровней липопротеинов низкой и очень низкой плотности, Подобные изменения тесно связаны с развитием сердечно-сосудистой патологии с высокой смертностью. Постепенно снижается содержание в крови липопротеинов высокой плотности (ЛВП), а также реверсивный транспорт холестерина. Таким образом утрачиваются их антиатерогенные, антиоксидантные и противовоспалительные функции. Основные компоненты ЛВП – аполипопротеины апоА-I и апоА-II, обеспечивающие функциональность, замещаются острофазовыми белками, а ЛВП лишаются своего кардиопротективного потенциала и приобретают провоспалительный и проатерогенный фенотип. По современным представлениям, дисфункция ЛВП, наряду с метаболическими сдвигами, в значительной степени обусловлена эпигенетическими нарушениями, влияющими на экспрессию генов и частично устраняемые назначением препаратов, содержащих микроРНК (мРНК) или антисмысловые нуклеотиды. Препараты с интерферирующими РНК, созданные в последние годы, с успехом применяются не только для лечения дислипидемии у нефрологических больных, но и пациентов с неопластическими процессами, воспалительными артритами, дегенеративными заболеваниями ЦНС, порфирией, гемофилией и многими другими заболеваниями. Предлагаемый обзор посвящен механизмам нарушений структуры и функций ЛВП у больных ХБП и коррекции этих нарушений.

Dyslipidemia develops in the initial stages of chronic kidney disease (CKD) and worsens as nephropathy progresses. The main manifestation of dyslipidemia is hypercholesterolemia, especially in nephrotic syndrome. However, with CKD of stages 4-5, it is replaced by hypertriglyceridemia in combination with an increase in blood levels of lipoproteins low and very low density. Such changes are closely related to the development of cardiovascular pathology with high mortality. The content of high-density lipoproteins (HDL) in the blood is gradually decreasing, as well as the reversible transport of cholesterol. Thus, their anti-atherogenic, antioxidant and anti-inflammatory functions are lost. The main components of HDL – apolipoproteins ApoA-I and ApoA-II, which provide functionality, are replaced by acute-phase proteins, and HDL lose their cardioprotective potential and acquire a proinflammatory and proatherogenic phenotype. According to modern concepts, HDL dysfunction, along with metabolic shifts, is largely due to epigenetic disorders affecting gene expression and partially eliminated by prescribing drugs containing microRNAs (mRNAs) or antisense nucleotides. Drugs with interfering RNAs created in recent years have been successfully used not only for the treatment of dyslipidemia in nephrological patients, but also in patients with neoplastic processes, inflammatory arthritis, degenerative diseases of the central nervous system, porphyria, hemophilia and many other diseases. The proposed review is devoted to the mechanisms of disorders of the structure and functions of HDL in patients with CKD and the correction of these disorders.

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