66 research outputs found
Remodeling of the vascular wall and endothelial function in patients with hypertension and underweight
Π’ΠΎ identify features of the remodeling of the vascular wall and endothelial function of peripheral arteries in patients with hypertension and underweight, were examined in 50 patients with a diagnosis of ΠΠ II st. and the normal ranges of body weight and 49 patients with ΠΠ II st. and underweight. The control group consisted of 30 volunteers without chronic diseases affecting hemodynamic parameters. All patients included in the study, performed duplex scanning of common carotid arteries (CCA). To assess the functional state of the endothelium was performed test with post-occlusive reactive hyperemia according to the classical method proposed by D.S. Celermajer modification O.V. Ivanova. As a result of the study showed that patients with hypertension and underweight, the leading type of structural and functional restructuring of the blood vessels the CCA is remodeling with the formation of predominantly concentric hypertrophy of the option, whereas in patients with AH and normal body weight leading place belongs to the inner concentric remodeling. Have we surveyed patients hypertension, regardless of body mass variations in the mechanisms of regulation of smooth muscle cells of the vessel wall lead to the development of the vasoconstrictor reactions and remodeling of the vascular bed, which in patients with hypertension and underweight gets more pronounced morphological component compared with patients with hypertension having normal body weight. This appears to be due to more significant increase in the blood levels of endothelin-1, whose effects on smooth muscle cells of the vascular wall in patients of this group to become dominant.Π‘ ΡΠ΅Π»ΡΡ Π²ΡΡΠ²ΠΈΡΡ ΠΎΡΠΎΠ±Π΅Π½Π½ΠΎΡΡΠΈ ΡΠ΅ΠΌΠΎΠ΄Π΅Π»ΠΈΡΠΎΠ²Π°Π½ΠΈΡ ΡΠΎΡΡΠ΄ΠΈΡΡΠΎΠΉ ΡΡΠ΅Π½ΠΊΠΈ ΠΈ ΡΠ½Π΄ΠΎΡΠ΅Π»ΠΈΠ°Π»ΡΠ½ΠΎΠΉ ΡΡΠ½ΠΊΡΠΈΠΈ ΠΏΠ΅ΡΠΈΡΠ΅ΡΠΈΡΠ΅ΡΠΊΠΈΡ
Π°ΡΡΠ΅ΡΠΈΠΉ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΠ ΠΈ Π΄Π΅ΡΠΈΡΠΈΡΠΎΠΌ ΠΌΠ°ΡΡΡ ΡΠ΅Π»Π°, Π±ΡΠ»ΠΎ ΠΎΠ±ΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΎ 50 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ Π΄ΠΈΠ°Π³Π½ΠΎΠ·ΠΎΠΌ ΠΠ II ΡΡ. ΠΈ Π½ΠΎΡΠΌΠ°Π»ΡΠ½ΡΠΌΠΈ Π·Π½Π°ΡΠ΅Π½ΠΈΡΠΌΠΈ ΠΌΠ°ΡΡΡ ΡΠ΅Π»Π° ΠΈ 49 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΠ II ΡΡ. ΠΈ Π΄Π΅ΡΠΈΡΠΈΡΠΎΠΌ ΠΌΠ°ΡΡΡ ΡΠ΅Π»Π°. ΠΠΎΠ½ΡΡΠΎΠ»ΡΠ½ΡΡ Π³ΡΡΠΏΠΏΡ ΡΠΎΡΡΠ°Π²ΠΈΠ»ΠΈ 30 Π΄ΠΎΠ±ΡΠΎΠ²ΠΎΠ»ΡΡΠ΅Π², Π½Π΅ ΠΈΠΌΠ΅ΡΡΠΈΡ
Ρ
ΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠΈΡ
Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΠΉ, ΠΎΠΊΠ°Π·ΡΠ²Π°ΡΡΠΈΡ
Π²Π»ΠΈΡΠ½ΠΈΠ΅ Π½Π° Π³Π΅ΠΌΠΎΠ΄ΠΈΠ½Π°ΠΌΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»ΠΈ. ΠΡΠ΅ΠΌ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ°ΠΌ, Π²ΠΊΠ»ΡΡΠ΅Π½Π½ΡΠΌ Π² ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅, Π²ΡΠΏΠΎΠ»Π½ΡΠ»ΠΎΡΡ Π΄ΡΠΏΠ»Π΅ΠΊΡΠ½ΠΎΠ΅ ΡΠΊΠ°Π½ΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅ ΠΎΠ±ΡΠΈΡ
ΡΠΎΠ½Π½ΡΡ
Π°ΡΡΠ΅ΡΠΈΠΉ (ΠΠ‘Π). ΠΠ»Ρ ΠΎΡΠ΅Π½ΠΊΠΈ ΡΡΠ½ΠΊΡΠΈΠΎΠ½Π°Π»ΡΠ½ΠΎΠ³ΠΎ ΡΠΎΡΡΠΎΡΠ½ΠΈΡ ΡΠ½Π΄ΠΎΡΠ΅Π»ΠΈΡ Π²ΡΠΏΠΎΠ»Π½ΡΠ»Π°ΡΡ ΠΏΡΠΎΠ±Π° Ρ ΠΏΠΎΡΡΠΎΠΊΠΊΠ»ΡΠ·ΠΈΠΎΠ½Π½ΠΎΠΉ ΡΠ΅Π°ΠΊΡΠΈΠ²Π½ΠΎΠΉ Π³ΠΈΠΏΠ΅ΡΠ΅ΠΌΠΈΠ΅ΠΉ ΠΏΠΎΠΊΠ»Π°ΡΡΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΌΠ΅ΡΠΎΠ΄ΠΈΠΊΠ΅, ΠΏΡΠ΅Π΄Π»ΠΎΠΆΠ΅Π½Π½ΠΎΠΉ D.S. Celermajer Π² ΠΌΠΎΠ΄ΠΈΡΠΈΠΊΠ°ΡΠΈΠΈ Π.Π. ΠΠ²Π°Π½ΠΎΠ²ΠΎΠΉ. Π ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠ΅ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½Π½ΠΎΠ³ΠΎ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ ΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½ΠΎ, ΡΡΠΎ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΠ ΠΈ Π΄Π΅ΡΠΈΡΠΈΡΠΎΠΌ ΠΌΠ°ΡΡΡ ΡΠ΅Π»Π°, Π²Π΅Π΄ΡΡΠΈΠΌ ΡΠΈΠΏΠΎΠΌ ΡΡΡΡΠΊΡΡΡΠ½ΠΎ-ΡΡΠ½ΠΊΡΠΈΠΎΠ½Π°Π»ΡΠ½ΠΎΠΉ ΠΏΠ΅ΡΠ΅ΡΡΡΠΎΠΉΠΊΠΈ ΡΠΎΡΡΠ΄ΠΎΠ² ΠΠ‘Π ΡΠ²Π»ΡΠ΅ΡΡΡ ΡΠ΅ΠΌΠΎΠ΄Π΅Π»ΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅ Ρ ΡΠΎΡΠΌΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅ΠΌ ΠΏΡΠ΅ΠΈΠΌΡΡΠ΅ΡΡΠ²Π΅Π½Π½ΠΎ ΠΊΠΎΠ½ΡΠ΅Π½ΡΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π²Π°ΡΠΈΠ°Π½ΡΠ° Π³ΠΈΠΏΠ΅ΡΡΡΠΎΡΠΈΠΈ, ΡΠΎΠ³Π΄Π° ΠΊΠ°ΠΊ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΠ ΠΈ Π½ΠΎΡΠΌΠ°Π»ΡΠ½ΠΎΠΉ ΠΌΠ°ΡΡΠΎΠΉ ΡΠ΅Π»Π° Π»ΠΈΠ΄ΠΈΡΡΡΡΠ΅Π΅ ΠΌΠ΅ΡΡΠΎ ΠΏΡΠΈΠ½Π°Π΄Π»Π΅ΠΆΠΈΡ Π²Π½ΡΡΡΠ΅Π½Π½Π΅ΠΌΡ ΠΊΠΎΠ½ΡΠ΅Π½ΡΡΠΈΡΠ΅ΡΠΊΠΎΠΌΡ ΡΠ΅ΠΌΠΎΠ΄Π΅Π»ΠΈΡΠΎΠ²Π°Π½ΠΈΡ. Π£ ΠΎΠ±ΡΠ»Π΅Π΄ΠΎΠ²Π°Π½Π½ΡΡ
Π½Π°ΠΌΠΈ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΠΠ Π½Π΅Π·Π°Π²ΠΈΡΠΈΠΌΠΎ ΠΎΡ ΠΌΠ°ΡΡΡ ΡΠ΅Π»Π° Π²ΠΎΠ·Π½ΠΈΠΊΠ°ΡΡΠΈΠ΅ ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΡ Π² ΠΌΠ΅Ρ
Π°Π½ΠΈΠ·ΠΌΠ°Ρ
ΡΠ΅Π³ΡΠ»ΡΡΠΈΠΈ Π³Π»Π°Π΄ΠΊΠΎΠΌΡΡΠ΅ΡΠ½ΡΡ
ΠΊΠ»Π΅ΡΠΎΠΊ ΡΡΠ΅Π½ΠΊΠΈ ΡΠΎΡΡΠ΄Π° ΠΏΡΠΈΠ²ΠΎΠ΄ΡΡ ΠΊ ΡΠ°Π·Π²ΠΈΡΠΈΡ Π²Π°Π·ΠΎΠΊΠΎΠ½ΡΡΡΠΈΠΊΡΠΎΡΠ½ΡΡ
ΡΠ΅Π°ΠΊΡΠΈΠΉ ΠΈ ΡΠ΅ΠΌΠΎΠ΄Π΅Π»ΠΈΡΠΎΠ²Π°Π½ΠΈΡ ΡΠΎΡΡΠ΄ΠΈΡΡΠΎΠ³ΠΎ ΡΡΡΠ»Π°, ΠΊΠΎΡΠΎΡΠΎΠ΅ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΠ ΠΈ Π΄Π΅ΡΠΈΡΠΈΡΠΎΠΌ ΠΌΠ°ΡΡΡ ΡΠ΅Π»Π° ΠΏΠΎΠ»ΡΡΠ°Π΅Ρ Π±ΠΎΠ»Π΅Π΅ Π²ΡΡΠ°ΠΆΠ΅Π½Π½ΡΡ ΠΌΠΎΡΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΡΡ ΡΠΎΡΡΠ°Π²Π»ΡΡΡΡΡ ΠΏΠΎ ΡΡΠ°Π²Π½Π΅Π½ΠΈΡ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ°ΠΌΠΈ Ρ ΠΠ, ΠΈΠΌΠ΅ΡΡΠΈΠΌΠΈ Π½ΠΎΡΠΌΠ°Π»ΡΠ½ΡΡ ΠΌΠ°ΡΡΡ ΡΠ΅Π»Π°. ΠΡΠΎ, ΠΏΠΎ-Π²ΠΈΠ΄ΠΈΠΌΠΎΠΌΡ, ΠΎΠ±ΡΡΠ»ΠΎΠ²Π»Π΅Π½ΠΎ Π±ΠΎΠ»Π΅Π΅ Π·Π½Π°ΡΠΈΠΌΡΠΌ ΠΏΠΎΠ²ΡΡΠ΅Π½ΠΈΠ΅ΠΌ ΡΠΎΠ΄Π΅ΡΠΆΠ°Π½ΠΈΡ Π² ΠΊΡΠΎΠ²ΠΈ ΡΠ½Π΄ΠΎΡΠ΅Π»ΠΈΠ½Π°-1, Π²ΠΎΠ·Π΄Π΅ΠΉΡΡΠ²ΠΈΠ΅ ΠΊΠΎΡΠΎΡΠΎΠ³ΠΎ Π½Π° Π³Π»Π°Π΄ΠΊΠΎΠΌΡΡΠ΅ΡΠ½ΡΠ΅ ΠΊΠ»Π΅ΡΠΊΠΈ ΡΠΎΡΡΠ΄ΠΈΡΡΠΎΠΉ ΡΡΠ΅Π½ΠΊΠΈ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Π΄Π°Π½Π½ΠΎΠΉ Π³ΡΡΠΏΠΏΡ ΡΡΠ°Π½ΠΎΠ²ΠΈΡΡΡΡ Π΄ΠΎΠΌΠΈΠ½ΠΈΡΡΡΡΠΈΠΌ
Hepatocellular Carcinoma: Aetiology and Mechanisms of Development. A Literature Review
Liver cancer remains a global challenge of healthcare, with the incidence growing worldwide. According to various authors, over 1 million patients will be diagnosed with liver cancer each year by 2025. The molecular pathogenesis of HCC varies with respect to genotoxic lesions and aetiologies. Although our understanding of the HCC pathophysiology and drivers tends to improve, it is still distant from translation into clinical practice. About 25 % of HCC cases are associated with variant mutations. HCC pathophysiology is a complex multi-step process. The interaction of various factors underlies the early stages of malignant hepatocyte transformation towards the development of HCC. Overall, about 20β25 % of HCC patients have at least one potential driver mutation. Obesity should also be noted as being associated with a higher risk of HCC and various other cancers. Despite many issues in the HCC pathogenesis being already known, the unresolved questions remain. Modern molecular genetic diagnostics and animal modelling of malignant tumours are expanding our horizons of knowledge in this field
Features of structural and functional state of the vascular wall and endothelial function in patients with arterial hypertensia and different body weight
The study presents the results of the analysis of feature remodeling vascular wall among 100 patients with arterial hypertensia and different body weight. There is shown a dependence of structural and geometrical reorganization with presence or absence impairment of body weight. The study reveals that the patients with arterial hypertensia and absence body weight remodeling vascular wall proceeds with a more pronounced structural and geometrical changes in the form arteriosclerosis of common carotid artery in relation to patients with arterial hypertensia and βnormal" body weight and more pronounced remodeling vascular wall of peripheral blood vessels on example brachial artery.Π ΡΠ°Π±ΠΎΡΠ΅ ΠΏΡΠΈΠ²Π΅Π΄Π΅Π½Ρ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ Π°Π½Π°Π»ΠΈΠ·Π° ΠΎΡΠΎΠ±Π΅Π½Π½ΠΎΡΡΠ΅ΠΉ ΡΠ΅ΠΌΠΎΠ΄Π΅Π»ΠΈΡΠΎΠ²Π°Π½ΠΈΡ ΡΠΎΡΡΠ΄ΠΈΡΡΠΎΠΉ ΡΡΠ΅Π½ΠΊΠΈ Ρ 100 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ Π΄ΠΈΠ°Π³Π½ΠΎΠ·ΠΎΠΌ ΠΠ I-II ΡΡ. ΠΈ ΡΠ°Π·Π»ΠΈΡΠ½ΠΎΠΉ ΠΌΠ°ΡΡΠΎΠΉ ΡΠ΅Π»Π°. ΠΠΎΠΊΠ°Π·Π°Π½Π° Π·Π°Π²ΠΈΡΠΈΠΌΠΎΡΡΡ ΡΡΡΡΠΊΡΡΡΠ½ΠΎ-Π³Π΅ΠΎΠΌΠ΅ΡΡΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΏΠ΅ΡΠ΅ΡΡΡΠΎΠΉΠΊΠΈ ΡΠΎΡΡΠ΄ΠΈΡΡΠΎΠΉ ΡΡΠ΅Π½ΠΊΠΈ ΠΎΡ Π½Π°Π»ΠΈΡΠΈΡ ΠΈΠ»ΠΈ ΠΎΡΡΡΡΡΡΡΠ²ΠΈΡ Π΄Π΅ΡΠΈΡΠΈΡΠ° ΠΌΠ°ΡΡΡ ΡΠ΅Π»Π°. ΠΡΡΠ²Π»Π΅Π½ΠΎ ΡΡΠΎ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΠ ΠΈ Π΄Π΅ΡΠΈΡΠΈΡΠΎΠΌ ΠΌΠ°ΡΡΡ ΡΠ΅Π»Π° ΡΠ΅ΠΌΠΎΠ΄Π΅Π»ΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅ ΡΠΎΡΡΠ΄ΠΈΡΡΠΎΠΉ ΡΡΠ΅Π½ΠΊΠΈ ΠΏΡΠΎΡΠ΅ΠΊΠ°Π΅Ρ Ρ Π±ΠΎΠ»Π΅Π΅ Π²ΡΡΠ°ΠΆΠ΅Π½Π½ΡΠΌΠΈ ΡΡΡΡΠΊΡΡΡΠ½ΠΎ-ΡΡΠ½ΠΊΡΠΈΠΎΠ½Π°Π»ΡΠ½ΡΠΌΠΈ ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΡΠΌΠΈ Π² Π²ΠΈΠ΄Π΅ Π°ΡΡΠ΅ΡΠΈΠΎΡΠΊΠ»Π΅ΡΠΎΠ·Π° ΠΎΠ±ΡΠ΅ΠΉ ΡΠΎΠ½Π½ΠΎΠΉ Π°ΡΡΠ΅ΡΠΈΠΈ ΠΏΠΎ ΡΡΠ°Π²Π½Π΅Π½ΠΈΡ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ°ΠΌΠΈ Ρ ΠΠ ΠΈ Β«Π½ΠΎΡΠΌΠ°Π»ΡΠ½ΠΎΠΉΒ» ΠΌΠ°ΡΡΠΎΠΉ ΡΠ΅Π»Π° ΠΈ Π±ΠΎΠ»Π΅Π΅ Π²ΡΡΠ°ΠΆΠ΅Π½Π½ΠΎΠ΅ ΡΠ΅ΠΌΠΎΠ΄Π΅Π»ΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅ ΡΠΎΡΡΠ΄ΠΈΡΡΠΎΠΉ ΡΡΠ΅Π½ΠΊΠΈ ΠΏΠ΅ΡΠΈΡΠ΅ΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΡΠΎΡΡΠ΄ΠΎΠ² Π½Π° ΠΏΡΠΈΠΌΠ΅ΡΠ΅ ΠΏΠ»Π΅ΡΠ΅Π²ΠΎΠΉ Π°ΡΡΠ΅ΡΠΈΠΈ
ΠΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡΠΈ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΡ ΠΊΠΎΠΌΠ±ΠΈΠ½Π°ΡΠΈΠΈ Π»Π΅Π½Π²Π°ΡΠΈΠ½ΠΈΠ±Π° ΠΈ ΠΏΠ΅ΠΌΠ±ΡΠΎΠ»ΠΈΠ·ΡΠΌΠ°Π±Π° ΠΏΡΠΈ ΡΠ°ΡΠΏΡΠΎΡΡΡΠ°Π½Π΅Π½Π½ΠΎΠΉ ΡΠ½Π΄ΠΎΠΌΠ΅ΡΡΠΈΠ°Π»ΡΠ½ΠΎΠΉ ΠΊΠ°ΡΡΠΈΠ½ΠΎΠΌΠ΅
Endometrial cancer is one of the most common gynaecological cancers in both the United States and the Russian Federation, and the rate continues to rise. Although early-stage endometrial cancer is associated with a favourable 5-year survival rate (96%), this rate in patients with distant metastases accounts for only 18%. A combination of paclitaxel and carboplatin is standard first-line therapy for advanced, recurrent and metastatic endometrial carcinoma. Pembrolizumab, a monoclonal antibody targeting the programmed death-1 receptor, is approved for therapy of metastatic solid tumors with high microsatellite instability that have progressed aft er previous therapy and have no alternative treatment options. Lenvatinib is an oral multikinase inhibitor that blocks vascular endothelial growth factor receptors 1-3, fibroblast growth factor receptors 1-4, platelet-derived growth factor receptor alpha, RET and KIT. Phase II and III studies (KEYNOTE-146/ Study111 and KEYNOTE-775) on the combination of lenvatinib and pembrolizumab in advanced endometrial carcinoma, irrespective of MMR and MSI status, have shown new potential for the treatment of this pathology. Th e results obtained, including progression-free and overall survival, allow the combination of lenvatinib and pembrolizumab to be considered a new standard for the treatment of this pathology.Π Π°ΠΊ ΡΠ½Π΄ΠΎΠΌΠ΅ΡΡΠΈΡ ΡΠ²Π»ΡΠ΅ΡΡΡ ΠΎΠ΄Π½ΠΈΠΌ ΠΈΠ· Π½Π°ΠΈΠ±ΠΎΠ»Π΅Π΅ ΡΠ°ΡΠΏΡΠΎΡΡΡΠ°Π½Π΅Π½Π½ΡΡ
Π²ΠΈΠ΄ΠΎΠ² Π³ΠΈΠ½Π΅ΠΊΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΡΠ°ΠΊΠ° ΠΊΠ°ΠΊ Π² Π‘ΠΎΠ΅Π΄ΠΈΠ½Π΅Π½Π½ΡΡ
Π¨ΡΠ°ΡΠ°Ρ
, ΡΠ°ΠΊ ΠΈ Π² Π ΠΎΡΡΠΈΠΉΡΠΊΠΎΠΉ Π€Π΅Π΄Π΅ΡΠ°ΡΠΈΠΈ, ΠΈ ΡΡΠΎΡ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Ρ ΠΏΡΠΎΠ΄ΠΎΠ»ΠΆΠ°Π΅Ρ ΡΠ°ΡΡΠΈ. ΠΠ΅ΡΠΌΠΎΡΡΡ Π½Π° ΡΠΎ ΡΡΠΎ ΡΠ°Π½Π½ΠΈΠ΅ ΡΡΠ°Π΄ΠΈΠΈ ΡΠ°ΠΊΠ° ΡΠ½Π΄ΠΎΠΌΠ΅ΡΡΠΈΡ Π°ΡΡΠΎΡΠΈΠΈΡΡΡΡΡΡ Ρ Π±Π»Π°Π³ΠΎΠΏΡΠΈΡΡΠ½ΠΎΠΉ 5-Π»Π΅ΡΠ½Π΅ΠΉ Π²ΡΠΆΠΈΠ²Π°Π΅ΠΌΠΎΡΡΡΡ (96 %), Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠΊ Ρ ΠΎΡΠ΄Π°Π»Π΅Π½Π½ΡΠΌΠΈ ΠΌΠ΅ΡΠ°ΡΡΠ°Π·Π°ΠΌΠΈ ΡΡΠΎΡ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Ρ ΡΠΎΡΡΠ°Π²Π»ΡΠ΅Ρ Π²ΡΠ΅Π³ΠΎ Π»ΠΈΡΡ 18 %. ΠΠΎΠΌΠ±ΠΈΠ½Π°ΡΠΈΡ ΠΏΠ°ΠΊΠ»ΠΈΡΠ°ΠΊΡΠ΅Π»Π° ΠΈ ΠΊΠ°ΡΠ±ΠΎΠΏΠ»Π°ΡΠΈΠ½Π° ΡΠ²Π»ΡΠ΅ΡΡΡ ΡΡΠ°Π½Π΄Π°ΡΡΠ½ΡΠΌ ΡΠ΅ΠΆΠΈΠΌΠΎΠΌ ΠΏΠ΅ΡΠ²ΠΎΠΉ Π»ΠΈΠ½ΠΈΠΈ Π΄Π»Ρ Π»Π΅ΡΠ΅Π½ΠΈΡ ΠΏΡΠΎΠ³ΡΠ΅ΡΡΠΈΡΡΡΡΠ΅ΠΉ, ΡΠ΅ΡΠΈΠ΄ΠΈΠ²ΠΈΡΡΡΡΠ΅ΠΉ ΠΈ ΠΌΠ΅ΡΠ°ΡΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΊΠ°ΡΡΠΈΠ½ΠΎΠΌΡ ΡΠ½Π΄ΠΎΠΌΠ΅ΡΡΠΈΡ. ΠΠ΅ΠΌΠ±ΡΠΎΠ»ΠΈΠ·ΡΠΌΠ°Π±, ΠΌΠΎΠ½ΠΎΠΊΠ»ΠΎΠ½Π°Π»ΡΠ½ΠΎΠ΅ Π°Π½ΡΠΈΡΠ΅Π»ΠΎ, Π½Π°ΡΠ΅Π»Π΅Π½Π½ΠΎΠ΅ Π½Π° ΡΠ΅ΡΠ΅ΠΏΡΠΎΡ Π·Π°ΠΏΡΠΎΠ³ΡΠ°ΠΌΠΌΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠΉ ΡΠΌΠ΅ΡΡΠΈ-1, ΠΎΠ΄ΠΎΠ±ΡΠ΅Π½ Π΄Π»Ρ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ ΠΌΠ΅ΡΠ°ΡΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΡΠΎΠ»ΠΈΠ΄Π½ΡΡ
ΠΎΠΏΡΡ
ΠΎΠ»Π΅ΠΉ Ρ Π²ΡΡΠΎΠΊΠΎΠΉ ΠΌΠΈΠΊΡΠΎΡΠ°ΡΠ΅Π»Π»ΠΈΡΠ½ΠΎΠΉ Π½Π΅ΡΡΠ°Π±ΠΈΠ»ΡΠ½ΠΎΡΡΡΡ, ΠΊΠΎΡΠΎΡΡΠ΅ ΠΏΡΠΎΠ³ΡΠ΅ΡΡΠΈΡΠΎΠ²Π°Π»ΠΈ ΠΏΠΎΡΠ»Π΅ ΠΏΡΠ΅Π΄ΡΠ΅ΡΡΠ²ΡΡΡΠ΅ΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ ΠΈ Π½Π΅ ΠΈΠΌΠ΅Π»ΠΈ Π°Π»ΡΡΠ΅ΡΠ½Π°ΡΠΈΠ²Π½ΡΡ
Π²Π°ΡΠΈΠ°Π½ΡΠΎΠ² Π»Π΅ΡΠ΅Π½ΠΈΡ. ΠΠ΅Π½Π²Π°ΡΠΈΠ½ΠΈΠ± ΡΠ²Π»ΡΠ΅ΡΡΡ ΠΏΠ΅ΡΠΎΡΠ°Π»ΡΠ½ΡΠΌ ΠΌΡΠ»ΡΡΠΈΠΊΠΈΠ½Π°Π·Π½ΡΠΌ ΠΈΠ½Π³ΠΈΠ±ΠΈΡΠΎΡΠΎΠΌ, ΠΊΠΎΡΠΎΡΡΠΉ Π½Π°ΡΠ΅Π»Π΅Π½ Π½Π° ΡΠ΅ΡΠ΅ΠΏΡΠΎΡΡ ΡΠ°ΠΊΡΠΎΡΠ° ΡΠΎΡΡΠ° ΡΠ½Π΄ΠΎΡΠ΅Π»ΠΈΡ ΡΠΎΡΡΠ΄ΠΎΠ² 1β3, ΡΠ΅ΡΠ΅ΠΏΡΠΎΡΡ ΡΠ°ΠΊΡΠΎΡΠ° ΡΠΎΡΡΠ° ΡΠΈΠ±ΡΠΎΠ±Π»Π°ΡΡΠΎΠ² 1β4, ΡΠ΅ΡΠ΅ΠΏΡΠΎΡ ΡΠ°ΠΊΡΠΎΡΠ° ΡΠΎΡΡΠ° ΡΡΠΎΠΌΠ±ΠΎΡΠΈΡΠΎΠ²-a, RET ΠΈ KIT. ΠΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ II ΠΈ III ΡΠ°Π·Ρ (KEYNOTE-146/Study111 ΠΈ KEYNOTE-775), ΠΏΠΎΡΠ²ΡΡΠ΅Π½Π½ΡΠ΅ ΠΊΠΎΠΌΠ±ΠΈΠ½Π°ΡΠΈΠΈ Π»Π΅Π½Π²Π°ΡΠΈΠ½ΠΈΠ±Π° ΠΈ ΠΏΠ΅ΠΌΠ±ΡΠΎΠ»ΠΈΠ·ΡΠΌΠ°Π±Π° ΠΏΡΠΈ ΡΠ°ΡΠΏΡΠΎΡΡΡΠ°Π½Π΅Π½Π½ΠΎΠΉ ΡΠ½Π΄ΠΎΠΌΠ΅ΡΡΠΈΠ°Π»ΡΠ½ΠΎΠΉ ΠΊΠ°ΡΡΠΈΠ½ΠΎΠΌΠ΅ Π²Π½Π΅ Π·Π°Π²ΠΈΡΠΈΠΌΠΎΡΡΠΈ ΠΎΡ ΡΡΠ°ΡΡΡΠ° MMR ΠΈ MSI, ΠΏΡΠΎΠ΄Π΅ΠΌΠΎΠ½ΡΡΡΠΈΡΠΎΠ²Π°Π»ΠΈ Π½ΠΎΠ²ΡΠ΅ Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡΠΈ Π² Π»Π΅ΡΠ΅Π½ΠΈΠΈ ΡΡΠΎΠΉ ΠΏΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΠΈ. ΠΠΎΠ»ΡΡΠ΅Π½Π½ΡΠ΅ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ, Π² ΡΠΎΠΌ ΡΠΈΡΠ»Π΅ ΠΈ Π²ΡΠΆΠΈΠ²Π°Π΅ΠΌΠΎΡΡΡ Π±Π΅Π· ΠΏΡΠΎΠ³ΡΠ΅ΡΡΠΈΡΠΎΠ²Π°Π½ΠΈΡ ΠΈ ΠΎΠ±ΡΠ°Ρ Π²ΡΠΆΠΈΠ²Π°Π΅ΠΌΠΎΡΡΡ, ΠΏΠΎΠ·Π²ΠΎΠ»ΡΡΡ ΡΠ°ΡΡΠΌΠ°ΡΡΠΈΠ²Π°ΡΡ ΠΊΠΎΠΌΠ±ΠΈΠ½Π°ΡΠΈΡ Π»Π΅Π½Π²Π°ΡΠΈΠ½ΠΈΠ±Π° ΠΈ ΠΏΠ΅ΠΌΠ±ΡΠΎΠ»ΠΈΠ·ΡΠΌΠ°Π±Π° ΠΊΠ°ΠΊ Π½ΠΎΠ²ΡΠΉ ΡΡΠ°Π½Π΄Π°ΡΡ Π² Π»Π΅ΡΠ΅Π½ΠΈΠΈ Π΄Π°Π½Π½ΠΎΠΉ ΠΏΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΠΈ
ΠΠ΅ΠΏΠ°ΡΠΎΡΠ΅Π»Π»ΡΠ»ΡΡΠ½Π°Ρ ΠΊΠ°ΡΡΠΈΠ½ΠΎΠΌΠ°: ΡΡΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΡΠ°ΠΊΡΠΎΡΡ ΠΈ ΠΌΠ΅Ρ Π°Π½ΠΈΠ·ΠΌΡ ΡΠ°Π·Π²ΠΈΡΠΈΡ. ΠΠ±Π·ΠΎΡ Π»ΠΈΡΠ΅ΡΠ°ΡΡΡΡ
Liver cancer remains a global challenge of healthcare, with the incidence growing worldwide. According to various authors, over 1 million patients will be diagnosed with liver cancer each year by 2025. The molecular pathogenesis of HCC varies with respect to genotoxic lesions and aetiologies. Although our understanding of the HCC pathophysiology and drivers tends to improve, it is still distant from translation into clinical practice. About 25 % of HCC cases are associated with variant mutations. HCC pathophysiology is a complex multi-step process. The interaction of various factors underlies the early stages of malignant hepatocyte transformation towards the development of HCC. Overall, about 20β25 % of HCC patients have at least one potential driver mutation. Obesity should also be noted as being associated with a higher risk of HCC and various other cancers. Despite many issues in the HCC pathogenesis being already known, the unresolved questions remain. Modern molecular genetic diagnostics and animal modelling of malignant tumours are expanding our horizons of knowledge in this field.Π Π°ΠΊ ΠΏΠ΅ΡΠ΅Π½ΠΈ ΠΎΡΡΠ°Π΅ΡΡΡ Π³Π»ΠΎΠ±Π°Π»ΡΠ½ΠΎΠΉ ΠΏΡΠΎΠ±Π»Π΅ΠΌΠΎΠΉ Π·Π΄ΡΠ°Π²ΠΎΠΎΡ
ΡΠ°Π½Π΅Π½ΠΈΡ, ΠΈ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π΅ΠΌΠΎΡΡΡ ΡΡΠΎΠΉ ΠΏΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΠ΅ΠΉ ΠΈΠΌΠ΅Π΅Ρ ΡΠ΅Π½Π΄Π΅Π½ΡΠΈΡ ΠΊ ΡΠΎΡΡΡ Π²ΠΎ Π²ΡΠ΅ΠΌ ΠΌΠΈΡΠ΅. ΠΠΎ ΠΎΡΠ΅Π½ΠΊΠ°ΠΌ ΡΠ°Π·Π½ΡΡ
Π°Π²ΡΠΎΡΠΎΠ² ΠΊ 2025 Π³ΠΎΠ΄Ρ Π±ΡΠ΄Π΅Ρ Π²ΡΡΠ²Π»ΡΡΡΡΡ Π΅ΠΆΠ΅Π³ΠΎΠ΄Π½ΠΎ Π±ΠΎΠ»Π΅Π΅ 1 ΠΌΠΈΠ»Π»ΠΈΠΎΠ½Π° ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ Π΄ΠΈΠ°Π³Π½ΠΎΠ·ΠΎΠΌ Β«ΡΠ°ΠΊ ΠΏΠ΅ΡΠ΅Π½ΠΈΒ». ΠΠΎΠ»Π΅ΠΊΡΠ»ΡΡΠ½ΡΠΉ ΠΏΠ°ΡΠΎΠ³Π΅Π½Π΅Π· Π³Π΅ΠΏΠ°ΡΠΎΡΠ΅Π»Π»ΡΠ»ΡΡΠ½ΠΎΠΉ ΠΊΠ°ΡΡΠΈΠ½ΠΎΠΌΡ (ΠΠ¦Π) Π²Π°ΡΡΠΈΡΡΠ΅Ρ Π² Π·Π°Π²ΠΈΡΠΈΠΌΠΎΡΡΠΈ ΠΎΡ ΡΠ°Π·Π»ΠΈΡΠ½ΡΡ
Π³Π΅Π½ΠΎΡΠΎΠΊΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΏΠΎΡΠ°ΠΆΠ΅Π½ΠΈΠΉ ΠΈ ΡΡΠΈΠΎΠ»ΠΎΠ³ΠΈΠΈ. Π₯ΠΎΡΡ Π½Π°ΡΠΈ ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»Π΅Π½ΠΈΡ ΠΎ ΠΏΠ°ΡΠΎΡΠΈΠ·ΠΈΠΎΠ»ΠΎΠ³ΠΈΠΈ ΠΈ Π΄ΡΠ°ΠΉΠ²Π΅ΡΠ°Ρ
ΠΠ¦Π ΠΈΠΌΠ΅ΡΡ ΡΠ΅Π½Π΄Π΅Π½ΡΠΈΡ ΠΊ ΡΠ»ΡΡΡΠ΅Π½ΠΈΡ, ΡΡΠΈ ΠΏΠΎΠ½ΠΈΠΌΠ°Π½ΠΈΡ Π΅ΡΠ΅ Π΄Π°Π»Π΅ΠΊΠΈ Π΄Π»Ρ Π²ΠΎΠΏΠ»ΠΎΡΠ΅Π½ΠΈΡ Π² ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΡΡ ΠΏΡΠ°ΠΊΡΠΈΠΊΡ. ΠΡΠΈΠΌΠ΅ΡΠ½ΠΎ 25 % ΡΠ»ΡΡΠ°Π΅Π² ΠΠ¦Π ΡΠ²ΡΠ·Π°Π½Ρ Ρ ΡΠ°Π·Π»ΠΈΡΠ½ΡΠΌΠΈ ΠΌΡΡΠ°ΡΠΈΡΠΌΠΈ. ΠΠ°ΡΠΎΡΠΈΠ·ΠΈΠΎΠ»ΠΎΠ³ΠΈΡ ΠΠ¦Π ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»ΡΠ΅Ρ ΡΠΎΠ±ΠΎΠΉ ΡΠ»ΠΎΠΆΠ½ΡΠΉ ΠΌΠ½ΠΎΠ³ΠΎΡΡΠ°ΠΏΠ½ΡΠΉ ΠΏΡΠΎΡΠ΅ΡΡ. ΠΠ·Π°ΠΈΠΌΠΎΠ΄Π΅ΠΉΡΡΠ²ΠΈΠ΅ ΡΠ°Π·Π»ΠΈΡΠ½ΡΡ
ΡΠ°ΠΊΡΠΎΡΠΎΠ² Π»Π΅ΠΆΠΈΡ Π² ΠΎΡΠ½ΠΎΠ²Π΅ ΡΠ°Π½Π½ΠΈΡ
ΡΡΠ°Π΄ΠΈΠΉ Π·Π»ΠΎΠΊΠ°ΡΠ΅ΡΡΠ²Π΅Π½Π½ΠΎΠΉ ΡΡΠ°Π½ΡΡΠΎΡΠΌΠ°ΡΠΈΠΈ Π³Π΅ΠΏΠ°ΡΠΎΡΠΈΡΠΎΠ² ΠΈ ΡΠ°Π·Π²ΠΈΡΠΈΠΈ ΠΠ¦Π. Π ΡΠ΅Π»ΠΎΠΌ ΡΠΎΠ»ΡΠΊΠΎ ΠΏΡΠΈΠΌΠ΅ΡΠ½ΠΎ 20β25 % ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΠ¦Π ΠΈΠΌΠ΅ΡΡ ΠΊΠ°ΠΊ ΠΌΠΈΠ½ΠΈΠΌΡΠΌ ΠΎΠ΄Π½Ρ ΠΏΠΎΡΠ΅Π½ΡΠΈΠ°Π»ΡΠ½ΡΡ Π΄ΡΠ°ΠΉΠ²Π΅ΡΠ½ΡΡ ΠΌΡΡΠ°ΡΠΈΡ. Π’Π°ΠΊΠΆΠ΅ ΡΠ»Π΅Π΄ΡΠ΅Ρ ΠΎΡΠΌΠ΅ΡΠΈΡΡ, ΡΡΠΎ ΠΎΠΆΠΈΡΠ΅Π½ΠΈΠ΅ ΡΠ²ΡΠ·Π°Π½ΠΎ Ρ ΠΏΠΎΠ²ΡΡΠ΅Π½Π½ΡΠΌ ΡΠΈΡΠΊΠΎΠΌ ΡΠ°Π·Π²ΠΈΡΠΈΡ ΠΠ¦Π ΠΈ ΡΠ°ΠΊΠ° Π²ΠΎ ΠΌΠ½ΠΎΠ³ΠΈΡ
ΠΎΡΠ³Π°Π½Π°Ρ
. ΠΠ΅ΡΠΌΠΎΡΡΡ Π½Π° ΠΌΠ½ΠΎΠ³ΠΈΠ΅ ΡΠΆΠ΅ ΠΈΠ·Π²Π΅ΡΡΠ½ΡΠ΅ ΠΌΠΎΠΌΠ΅Π½ΡΡ Π² ΠΏΠ°ΡΠΎΠ³Π΅Π½Π΅Π·Π΅ ΡΠ°Π·Π²ΠΈΡΠΈΡ ΠΠ¦Π, Π΅ΡΠ΅ ΠΎΡΡΠ°ΡΡΡΡ Π½Π΅ΡΠ΅ΡΠ΅Π½Π½ΡΠ΅ Π²ΠΎΠΏΡΠΎΡΡ. Π‘ΠΎΠ²ΡΠ΅ΠΌΠ΅Π½Π½ΡΠ΅ Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡΠΈ ΠΌΠΎΠ»Π΅ΠΊΡΠ»ΡΡΠ½ΠΎ-Π³Π΅Π½Π΅ΡΠΈΡΠ΅ΡΠΊΠΎΠΉ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠΈ ΠΈ ΠΌΠΎΠ΄Π΅Π»ΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅ Π·Π»ΠΎΠΊΠ°ΡΠ΅ΡΡΠ²Π΅Π½Π½ΡΡ
ΠΎΠΏΡΡ
ΠΎΠ»Π΅ΠΉ Π½Π° ΠΆΠΈΠ²ΠΎΡΠ½ΡΡ
ΠΏΠΎΠ·Π²ΠΎΠ»ΡΡΡ ΡΠ°ΡΡΠΈΡΠΈΡΡ Π³ΠΎΡΠΈΠ·ΠΎΠ½ΡΡ Π·Π½Π°Π½ΠΈΠΉ Π² ΡΡΠΎΠΉ ΠΎΠ±Π»Π°ΡΡΠΈ
O 4-ΠΊΠΎΠ²Π°ΡΠΈΠ°Π½ΡΠ½ΡΠΉ Π³Π°ΠΌΠΈΠ»ΡΡΠΎΠ½ΠΎΠ² ΡΠΎΡΠΌΠ°Π»ΠΈΠ·ΠΌ Π΄Π»Ρ ΡΠΈΠ½ΠΈΡΠ½ΠΎΠ³ΠΎ Π΄Π²ΠΈΠΆΠ΅Π½ΠΈΡ Π² ΡΠ΅Π½ΡΡΠ°Π»ΡΠ½ΠΎΠΌ ΠΏΠΎΠ»Π΅.
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