medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2023-481medsovet-8013Research ArticleГАСТРОЭНТЕРОЛОГИЯGASTROENTEROLOGYАктуальные вопросы терапии пациентов с язвенным колитомTopical issues of therapy for patients with ulcerative colitishttps://orcid.org/0000-0002-1095-8787ГриневичВ. Б.GrinevichV. B.

Гриневич Владимир Борисович - д.м.н., профессор, заведующий 2-й кафедрой (терапии усовершенствования врачей).

194044, Санкт-Петербург, ул. Академика Лебедева, д. 6

Vladimir B. Grinevich - Dr. Sci. (Med.), Professor, Head of the 2nd Department of Advanced Medical Training.

6, Akademik Lebedev St., St Petersburg, 194044

grinevich_vb@mail.ruhttps://orcid.org/0009-0009-9562-3529ПершкоА. М.PershkoA. M.

Першко Анатолий Михайлович - д.м.н., доцент 2-й кафедры (терапии усовершенствования врачей).

194044, Санкт-Петербург, ул. Академика Лебедева, д. 6

Anatoliy M. Pershko - Dr. Sci. (Med.), Associate Professor of of the 2nd Department of Advanced Medical Training.

6, Akademik Lebedev St., St Petersburg, 194044

pershkoam@mail.ruhttps://orcid.org/0009-0005-1945-6539ВолгаН. В.VolgaN. B.

Волга Наталья Борисовна - к.м.н., старший преподаватель 2-й кафедры (терапии усовершенствования врачей).

194044, Санкт-Петербург, ул. Академика Лебедева, д. 6

Natalia B. Volga - Cand. Sci. (Med.), Senior Lecturer of the 2nd Department of Advanced Medical Training.

6, Akademik Lebedev St., St Petersburg, 194044

n.b.volga@yandex.ruhttps://orcid.org/0000-0002-2785-6699ИванюкЕ. С.IvanyukE. S.

Иванюк Елена Сергеевна - к.м.н. доцент 2-й кафедры (терапии усовершенствования врачей).

194044, Санкт-Петербург, ул. Академика Лебедева, д. 6

Elena S. Ivanyuk - Cand. Sci. (Med.), Associate Professor of the 2nd Department of Advanced Medical Training.

6, Akademik Lebedev St., St Petersburg, 194044

ivanyuk-es@yandex.ruhttps://orcid.org/0000-0001-5623-4226СеливёрстовП. В.SeliverstovP. V.

Селивёрстов Павел Васильевич - к.м.н., доцент 2-й кафедры (терапии усовершенствования врачей).

194044, Санкт-Петербург, ул. Академика Лебедева, д. 6

Pavel V. Seliverstov - Cand. Sci. (Med.), Associate Professor of the 2nd Department of Advanced Medical Training.

6, Akademik Lebedev St., St Petersburg, 194044

seliverstov-pv@yandex.ruВоенно-медицинская академия имени С.М. КироваРоссияMilitary Medical Academy named after S.M. KirovRussian Federation202319012024023149154Copyright © Гриневич В.Б., Першко А.М., Волга Н.В., Иванюк Е.С., Селивёрстов П.В., 20242024Гриневич В.Б., Першко А.М., Волга Н.В., Иванюк Е.С., Селивёрстов П.В.Grinevich V.B., Pershko A.M., Volga N.B., Ivanyuk E.S., Seliverstov P.V.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/8013

Язвенный колит – это иммуновоспалительное (аутоиммунное) заболевание, характеризующееся язвенно-деструктивными процессами в слизистой оболочке толстой кишки. Несмотря на достижения в фармакологической промышленности его распространенность в мире ежегодно увеличивается. Этиология язвенного колита на сегодняшний день до конца неизвестна. По современным представлениям язвенный колит рассматривают как многофакторное заболевание, в патогенезе которого обсуждаются генетическая детерминированность, нарушения кишечной микробиоты с сокращением популяций анаэробных бактерий в сочетании с триггерным действием факторов внешней среды. С высокой вероятностью ведущие патогенетические механизмы заболевания ассоциируются с поляризацией иммунного ответа по Th2-типу, для которого характерен синтез ИЛ-4, ИЛ-5, ИЛ-9 и ИЛ-13, который регулируется STAT-5 и Gata-3. В процессе развития заболевания в иммунопатологический процесс также вовлекается Th17-тип иммунного ответа, но уже с участием факторов транскрипции STAT-3 и ROR-γt и синтезом ИЛ-17, ИЛ-2, ИЛ-6, ИЛ-26 и ИЛ-22, а также хемокина CCL20. Диета и образ жизни являются частью глобальных руководящих принципов терапии пациентов с язвенным колитом. В качестве препаратов базисной терапии используются производные 5-аминосалициловой кислоты: комбинированные препараты и препараты чистой 5-аминосалициловой кислоты. Тем не менее для контроля активности заболевания показано назначение системных глюкокортикостероидов. Однако, как показывает наша практика, они эффективны, но только при первой атаке и последующих 2–3 рецидивах заболевания с последующей высокой частотой развития гормонорезистентности. На сегодняшний день существуют современные лекарственные средства с различным механизмом действия, позволяющие добиться стойкой ремиссии и повышения качества жизни пациентов. Среди них особый интерес в терапии язвенного колита представляют ингибиторы JAK – тофацитиниб. Это первый препарат для перорального приема, способный индуцировать и поддерживать бесстероидную ремиссию. Выбор того или иного препарата определяется опытом использования, стоимостью и национальными рекомендациями.

Ulcerative colitis is an autoimmune disease characterized by ulcerative destructive processes in the mucous membrane of the colon. Despite advances in the pharmaceutical industry, its prevalence in the world is increasing every year. The etiology of UC is currently unknown to the end. According to modern concepts, ulcerative colitis is considered as a multifactorial disease, in the pathogenesis of which genetic determinism, disorders of the intestinal microbiota with a decrease in populations of anaerobic bacteria in combination with the trigger action of environmental factors are discussed. With high probability, the leading pathogenetic mechanisms of the disease are associated with the polarization of the Th2-type immune response, which is characterized by the synthesis of IL-4, IL-5, IL-9 and IL-13, which is regulated by STAT-5 and Gata-3. During the development of the disease, Th17, a type of immune response, is also involved in the immunopathological process, but with the participation of transcription factors STAT-3 and ROR-yt and the synthesis of IL-17, IL-2, IL-6, IL-26 and IL-22, as well as chemokine CCL20. Diet and lifestyle are part of the global guidelines for the treatment of patients with ulcerative colitis. Derivatives of 5-aminosalicylic acid are used as basic therapy preparations: combined preparations and preparations of pure 5-aminosalicylic acid. Nevertheless, the administration of systemic glucocorticosteroids is indicated to control the activity of the disease. However, as our practice shows, they are effective, but only at the first attack and subsequent 2-3 relapses of the disease, followed by a high incidence of hormone resistance. To date, there are modern medicines with a different mechanism of action, allowing achieving stable remission and improving the quality of life of patients. Among them, JAK -tofacitinib inhibitors are of particular interest in the treatment of ulcerative colitis. This is the first oral drug capable of inducing and maintaining steroidal remission. The choice of a particular drug is determined by the experience of use, cost and national recommendations.

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