Дисфункция липопротеинов у больных с хронической болезнью почек (ХБП). Патогенез и лечение ХБП – дислипидемии (обзор литературы)

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.

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