CАХАРНЫЙ ДИАБЕТ 1-го ТИПА И БРОНХИАЛЬНАЯ АСТМА У ДЕТЕЙ: ВЗАИМОСВЯЗЬ И ВЗАИМОВЛИЯНИЕ. НАУЧНЫЙ ОБЗОР
Аннотация
Цель научного обзора — систематизация и анализ имеющихся в литературе данных по эпидемиологии, патогенезу, клинической картине, а также терапии детей с сочетанной патологией: бронхиальная астма + сахарный диабет 1-го типа пациентов в контексте коморбидности или самостоятельности/антиморбидности данных заболеваний. В результате проведенного исследования показано, что связь между сахарным диабетом 1-го типа (СД1) и бронхиальной астмой (БА) намного глубже и сложнее, чем существовавшая ранее парадигма Th1/Th2. При этом аллергические и аутоиммунные заболевания являются коморбидной патологией, тесно взаимосвязаны, оказывают влияние на дебют, последовательность возникновения клинических симптомов, характер контроля и особенность терапии друг друга. Научные данные свидетельствуют о существовании общей сложной полигенной основы формирования СД1 и БА. Возможно, именно генетические различия могут иметь решающее значение во взаимоотношениях сахарного диабета 1-го типа и бронхиальной астмы, но исследования в этом направлении должны быть продолжены. И поэтому современное представление о потенциальных патогенетических и иммунологических триггерах, играющих решающую роль в дебюте, течении и терапии сочетания БА+СД1, можно представить в виде тройственного взаимоотношения генетических факторов, окружающей среды и уникального цитокинового профиля у данных пациентов. Многофакторную связь в настоящее время следует рассматривать как двунаправленную по своей природе. При этом каждый элемент этой системы влияет на другие без четкого последовательного порядка возникновения. В основе патогенеза сочетанной патологии (СД1+БА) лежит иммунная дисрегуляция с цитокиновым дисбалансом (снижение количества и истощение резервных возможностей T-reg клеток, а также дефект подавляющего механизма IL-10). Следствием этого является появление/усиление воспалительного процесса, разбалансировка механизмов аутоиммунитета, что сопровождается еще большим нарушением иммунного гомеостаза и формированием/прогрессированием симптомов как БА, так и СД1.
Литература
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