Некротизирующий энтероколит новорожденных как фактор риска развития ретинопатии недоношенных. Обзор литературы
Ключевые слова:
ретинопатия недоношенных, некротизирующий энтероколит, кишечный микробиом, фактор роста эндотелия сосудов, обзорАннотация
В данном обзоре литературы предлагаем рассмотреть некротизирующий энтероколит (НЭК) как фактор риска развития ретинопатии недоношенных (РН). РН, являясь одной из доминирующих причин слепоты и слабовидения среди детского населения, считается важной проблемой здравоохранения. Множество эпидемиологических исследований выявили значимую взаимосвязь между НЭК и развитием РН, наряду с неонатальным сепсисом, бронхолегочной дисплазией, внутрижелудочковыми кровоизлияниями и открытым артериальным протоком. В исследованиях отмечено, что пациенты с НЭК, требующие хирургического лечения, имеют меньший гестационный возраст и меньшую массу тела при рождении, а частота встречаемости РН у данной группы пациентов составляет 55%. Одним из возможных связующих звеньев между НЭК и РН выделяют воспалительный стресс, который приводит к аномальному развитию сосудов сетчатки и увеличению сосудистых анастомозов. Отдельно стоит выделить микробиом кишечника, который имеет множественные перекрестные связи с различными органами, в том числе способен оказывать влияние на орган зрения. Так, микробиом участвует в патогенезе НЭК и может оказывать влияние на РН посредством связи с экспрессией фактора роста эндотелия сосудов, усиливая выработку цитокинов, препятствуя реваскуляризации тканей и восстановлению сосудов. Еще одним связующим звеном между микробиомом и РН может быть влияние кишечной флоры на развитие неонатального сепсиса и бронхолегочной дисплазии, которые также выделяют как факторы риска РН. Однако исследования о влиянии пробиотиков на течение РН противоречивы и требуют дальнейшего изучения. Таким образом, НЭК можно рассматривать как один из факторов риска развития и прогрессирования РН.
Библиографические ссылки
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