Патогенетические механизмы дисфункции гематоэнцефалического барьера при преэклампсии

Гипертензивные расстройства во время беременности относятся к наиболее сложным и нерешенным проблемам современного акушерства. На сегодняшний день их частота составляет от 12 до 40 % и не имеет тенденции к снижению. Около 60–70 % материнских смертей при гипертензивных расстройствах происходят из-за церебральных осложнений, вследствие развития эклампсии, отека головного мозга и инсульта. Недооценка степени тяжести состояния, неадекватное лечение и запоздалое родоразрешение являются основной причиной материнской заболеваемости и смертности. Несмотря на значительные успехи в понимании основных этапов патогенеза преэклампсии, механизмы повреждения эндотелиальных клеток сосудов головного мозга, а также особенности локальной паракринной и аутокринной регуляции цереброваскулярного кровотока в провоспалительных и гипоксических условиях, остаются актуальными для дальнейшего изучения. Данный литературный обзор посвящен изучению основных механизмов нарушения и/или повреждения гематоэнцефалического барьера при преэклампсии. Проведен систематический анализ современной отечественной и зарубежной литературы с использованием информационных баз eLibrary, Scopus, PubMed, MEDLINE и Cochrane Library за период с января 2010 г. по декабрь 2024 г. Представлена информация о роли фактора роста эндотелия сосудов и системы его рецепторов в увеличении трансклеточного транспорта, а также белков плотных контактов в усилении параклеточного пути. Описаны механизмы нарушения ауторегуляции мозгового кровотока, ведущие к развитию вазогенного отека головного мозга при преэклампсии и эклампсии. Понимание ключевых звеньев патогенеза повреждения гематоэнцефалического барьера при преэклампсии позволит в дальнейшем определить надежные и доступные ранние предикторы развития церебральной дисфункции при данном осложнении беременности.

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