medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2021-21-1-95-104medsovet-6617Research ArticleГАСТРОЭНТЕРОЛОГИЯGASTROENTEROLOGYАстения и утомление при гипераммониемии: этиопатогенез и методы коррекцииAsthenia and fatigue in hyperammonemia: etiopathogenesis and methods of correctionhttps://orcid.org/0000-0002-6150-1808ПлотниковаЕ. Ю.PlotnikovaE. Yu.

Плотникова Екатерина Юрьевна, д.м.н., профессор кафедры поликлинической терапии, последипломной подготовки и сестринского дела, руководитель курса клинической гастроэнтерологии

650029, Кемерово, ул. Ворошилова, д. 22а

Ekaterina Yu. Plotnikova, Dr. Sci. (Med.), Professor of the Department of Polyclinic Therapy, Postgraduate Training and Nursing, Head of the Clinical Gastroenterology Course

22a, Voroshilov St., Kemerovo, 650029

eka-pl@rambler.ruhttps://orcid.org/0000-0001-7604-5481СиньковаМ. Н.SinkovaM. N.

Синькова Маргарита Николаевна, к.м.н., доцент кафедры поликлинической терапии, последипломной подготовки и сестринского дела

650029, Кемерово, ул. Ворошилова, д. 22а

Margarita  N. Sinkova, Cand. Sci. (Med.), Associate Professor of  the Department of  Polyclinic Therapy, Postgraduate Training and Nursing 

22a, Voroshilov St., Kemerovo, 650029

margov@inbox.ruhttps://orcid.org/0000-0003-0487-3880ИсаковЛ. К.IsakovL. K.

Исаков Леонид Константинович, к.м.н., доцент кафедры поликлинической терапии, последипломной подготовки и сестринского дела

650029, Кемерово, ул. Ворошилова, д. 22а

Leonid K. Isakov, Cand. Sci. (Med.), Associate Professor of the Department of Polyclinic Therapy, Postgraduate Training and Nursing 

22a, Voroshilov St., Kemerovo, 650029

isakovy@inbox.ruКемеровский государственный медицинский университетРоссияKemerovo State Medical UniversityRussian Federation202107012022021-195104Copyright © Плотникова Е.Ю., Синькова М.Н., Исаков Л.К., 20222022Плотникова Е.Ю., Синькова М.Н., Исаков Л.К.Plotnikova E.Y., Sinkova M.N., Isakov L.K.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/6617

Астения и утомляемость – это наиболее часто встречающиеся синдромы у пациентов с заболеваниями печени, которые существенно влияют на  качество жизни. Распространенность утомляемости при хронических заболеваниях печени составляет от 50 до 85%. Хотя был достигнут некоторый прогресс в понимании процессов, которые могут вызывать утомление в целом, основные причины утомляемости, связанной с заболеванием печени, остаются не совсем понятны. В частности, многие исследования предполагают, что утомляемость, связанная с  заболеванием печени, вероятно, возникает в  результате изменений нейротрансмиссии в головном мозге на фоне гипераммониемии. Гипераммонемия – это метаболическое состояние, характеризующееся повышенным уровнем аммиака – азотсодержащего соединения. В настоящем обзоре описывается гипераммониемия, которая, вероятно, важна в патогенезе утомляемости, связанной с заболеванием печени. Аммиак является сильнодействующим нейротоксином, его повышенное содержание в крови может вызывать неврологические признаки и симптомы, которые могут быть острыми или хроническими в зависимости от основной патологии. Гипераммониемию следует распознать на ранней стадии и немедленно начать лечение, чтобы предотвратить развитие опасных для жизни осложнений, таких как отек головного мозга и кома. В статье приводятся патофизиологические механизмы влияния гипераммониемии на состояние психовегетативного статуса пациентов с  заболеваниями печени, а  также перечисляются основные принципы лечения. Значительная часть статьи уделена L-орнитину-L-аспартату, который эффективен при астении и утомляемости для снижения уровня гипераммониемии при хронических заболеваниях печени с помощью множества хорошо изученных механизмов.

Asthenia and fatigue are the most common syndromes in patients with liver disease, which significantly affects their quality of life. The prevalence of fatigue in chronic liver diseases is from 50% to 85%. While some progress has been made in understanding the processes that can cause fatigue in general, the underlying causes of fatigue associated with liver disease remain not well understood. In particular, many data suggest that fatigue associated with liver disease likely results from changes in neurotransmission in the brain against the background of hyperammonemia. Hyperammonemia is a metabolic state characterized by an increased level of  ammonia, a  nitrogen-containing compound. The  present review describes hyperammonemia, which is likely important in the pathogenesis of fatigue associated with liver disease. Ammonia is a potent neurotoxin, its elevated blood levels can cause neurological signs and symptoms that can be acute or chronic, depending on the  underlying pathology. Hyperammonemia should be recognized early, and immediately treated to prevent the development of life-threatening complications, such as, swelling of the brain and coma. The article gives pathophysiological mechanisms of influence of hyperammonemia on state of psychovegetative status of patients with liver diseases, also lists basic principles of treatment. A significant part of the article is devoted to L-ornithine-L-aspartate, which is effective in asthenia and fatigue to reduce the level of hyperammonemia through a variety of well-studied mechanisms in chronic liver diseases.

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