1 РНПЦ трансплантации органов и тканей УЗ «9-я городская клиническая больница», 2 УЗ «Минский городской диагностический центр», г. Минск, Республика Беларусь Центральный понтинный миелинолиз (ЦПМ)редкое, но крайне тяжелое осложнение после ортотопической трансплантации печени. Причина ЦПМ до настоящего времени точно не определена. Тем не менее быстрая коррекция гипонатриемии рассматривается как основной этиологический фактор. В настоящей статье нами представлены два клинических случая ЦПМ у пациентов, подвергшихся ортотопической трансплантации печени. Мы также обсуждаем патофизиологию, эпидемиологию, клиническую картину, способы лечения и меры профилактики ЦПМ.
Ключевые слова: гипонатриемия, центральный понтинный миелинолиз, трансплантация печени.Central pontine myelinolysis (CPM) is the rare, but extremely severe complication after orthotopic liver transplantation. The reason for CPM is currently not precisely defi ned. However, the rapid correction of hyponatremia is considered as the main etiological factor. In this paper we present two clinical cases of CPM in patients underwent orthotopic liver transplantation. We also discuss the pathophysiology, epidemiology, clinical presentation, treatment options and preventive measures of CPM.
Despite the fact that the key role of the liver in the formation of the immune response to injury is not in doubt, the mechanisms of weakening the immune response to infectious and noninfectious lesions in patients with hepatic failure remain unclear. We propose an original hypothesis of forming the ways to limit the amplitude of the systemic inflammatory response in patients with the end-stage liver disease. The basis of the hypothesis is the idea that as a result of reducing the intensity of the natural stimulation of membrane mCD14 receptors by the ligands of infectious nature, the basic mechanism of the systemic immune response induction by liver macrophages (
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