medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2015-13-80-85medsovet-340Research ArticleБОЛЕЗНИ ГЕПАТОБИЛИАРНОЙ СИСТЕМЫDISEASES OF THE HEPATOBILIARY SYSTEMАммиак как нейро- и гепатотоксин: клинические аспектыAmmonia as a neuro- and hepatotoxin: clinical aspectsБуеверовА. О.BueverovA. O.noemail@neicon.ruПервый Московский государственный медицинский университет им. И.М. СеченоваРоссияFirst Moscow State Medical University named after I.M. SechenovRussian Federation2015301220150138085Copyright © Буеверов А.О., 20152015Буеверов А.О.Bueverov A.O.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-sovet.pro/jour/article/view/340

Аммиак - наиболее хорошо изученный и, по-видимому, важнейший патогенетический фактор печеночной энцефалопатии (ПЭ). Патогенез ПЭ имеет некоторые различия в зависимости от варианта повреждения печени. Помимо нейротоксических, аммиак обладает универсальными цитотоксическими, в том числе гепатотоксическими свойствами. Недавно проведенное исследование позволило констатировать наличие гипераммониемии у пациентов с начальными изменениями печени, что ведет к латентной когнитивной дисфункции, проявляющейся нарушением реакции в стрессовых ситуациях. Медикаментозная терапия ПЭ направлена в первую очередь на предотвращение образования и ускорение метаболизма аммиака. Назначение метаболитов орнитина уменьшает гипераммониемию, способствует улучшению когнитивных функций и снижению активности трансаминаз, в том числе у пациентов с патологией печени на доцирротической стадии.

Ammonia is the most studied and, apparently, the most critical pathogenetic factor for hepatic encephalopathy (HE). The pathogenesis of PE is varied depending on the type of liver damage. Apart from neurotoxic properties, ammonia has general cytotoxic as well as hepatotoxic effects. A recent study allowed to register presence of hyperammonemia in patients with initial liver changes leading to latent cognitive dysfunction, which manifests itself in impaired reaction in stressful situations. Drug therapy of PE is primarily aimed at prevention and acceleration of metabolism of ammonia. Administration of ornithine metabolites reduces hyperammonemia, improves cognitive function and reduces enzyme activity, including in patients at pre-cirrhotic stage.

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