Механизмы повреждающего воздействия атипичных возбудителей на респираторный эпителий: инфекционная и постинфекционная гиперреактивность дыхательных путей у детей

Цель – проанализировать и обобщить имеющиеся на сегодняшнем этапе данные литературы о роли атипичных респираторных патогенов (Mycoplasma pneumoniae и Chlamydia pneumoniae) в развитии гиперреактивности дыхательных путей у детей. В статье представлены основные механизмы, посредством которых M. pneumoniae и Ch. pneumoniae могут повреждать клетки респираторного эпителия и способствовать формированию гиперреактивности бронхов. Показано, что повреждение эпителия происходит как напрямую, за счет истощения питательных ресурсов, окислительного стресса и нарушения механизмов восстановления, так и опосредованно, через иммунные механизмы, включая выработку специфических иммуноглобулин E-антител и дисбаланс цитокинов. Выделены особенности атипичных патогенов, приводящие к развитию тяжелых осложнений: продукция токсина внебольничного респираторного дистресс-синдрома (CARDS TX) M. pneumoniae, липополисахарида и белка теплового шока 60 Ch. pneumoniae. Отдельный раздел посвящен способности атипичных возбудителей формировать биоплёнки для повышения выживаемости и патогенности. Подчеркнуто, что повреждённый эпителий, в свою очередь, индуцирует продукцию провоспалительных медиаторов, тем самым усугубляя воспаление дыхательных путей и способствуя в ряде случаев формированию бронхиальной гиперреактивности. Раскрытие механизмов повреждающего воздействия атипичных возбудителей на дыхательные пути, по мнению авторов, позволит разработать новые подходы к диагностике, профилактике и лечению респираторных заболеваний у детей.

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