Перспективні напрямки для створення стратегії ефективної медикаментозної профілактики прееклампсії (Огляд літератури)
Бічна панель сторінки статті
Основний зміст сторінки статті
Анотація
Прееклампсія (ПЕ) є основною причиною захворюваності та смертності як матері, так і плода. Частота розвитку ПЕ становить від 2 % до 8 % випадків. Ускладнення, пов’язані із ПЕ, призводять щорічно до понад 50 000 материнських смертей та понад 500 000 смертей плода у всьому світі. В Україні у 2020 році ПЕ була діагностована в 11 075 жінок (39,32 на 1000 народжених), з них тяжка ПЕ – у 1573 жінок (5,58 на 1000 народжених).
Досягнення в акушерстві та неонатології суттєво пом’якшили багато небажаних наслідків вагітності, пов’язаних із ПЕ. Оптимальна профілактика ПЕ має важливе значення для запобігання захворюваності та смертності, пов’язаних з даною патологією. Зростає інтенсивність досліджень щодо виявлення нових терапевтичних засобів для профілактики або лікування ПЕ, ліків, які можуть впливати на патофізіологію захворювання. Основна цінність потенційних кандидатів для профілактики ПЕ полягає у передклінічному впливі на окиснювальний стрес, антиангіогенні фактори, а також тромбогенний потенціал та прозапальні шляхи розвитку патології.
Проведений систематичний пошук даних по базах MEDLINE, ISI Web of Science, PubMed, Scopus, Google Scholar та Proquest за 2014–2022 рр. У наведеному огляді проаналізовані результати доклінічних та клінічних досліджень стосовно раціональної профілактики розвитку ПЕ у вагітних групи ризику із залученням найбільш перспективних препаратів. Доклінічні дослідження запропонували нові молекулярно-таргетні стратегії, такі, як моноклональні антитіла, спрямовані на фактор некрозу пухлини альфа, фактор росту плаценти, і технологію коротких інтерферувальних рибонуклеїнових кислот для пригнічення експресії генів розчинної fms-подібної тирозинкінази-1 або ангіотензиногену.
Інші підходи до лікування, у яких перейдено до випробувань III фази (були завершені або тривають), включають інгібітори протонної помпи, метформін, донори та прекурсори оксиду азоту, рекомбінантний антитромбін III, імунний антиген дигоксину та мелатонін. Існують серії випадків, які свідчать, що видалення циркулюючої розчинної fms-подібної тирозинкінази-1 може допомогти стабілізувати ПЕ та пролонгувати вагітність.
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