Аннотация
В спектре гнойно-воспалительных заболеваний челюстно-лицевой области одним из самых тяжелых, вялотекущих осложнений одонтогенных и травматических нозологий является остеомиелит челюсти, доля которого, по данным разных авторов, достигает 30%. Актуальным патогенетическим механизмом формирования хронического остеомиелита челюсти, согласно современным представлениям, является нарушение метаболизма костной ткани, опосредованное влиянием патогенной микрофлоры и нарушениями микроциркуляции. В обзоре описаны возможности применения маркеров метаболизма костной ткани для прогнозирования течения заболевания, результативности проводимой терапии. Поисковая работа была проведена с использованием международных научных баз данных PubMed, ScienceDirect, Scopus, Cochrane Collaboration, Elsevier, а также электронных каталогов Центральной научной медицинской библиотеки РФ, библиотек elibrary.ru и cyberleninka.ru. Приведенные данные отразили наиболее информативные биомаркеры для оценки ремоделирования эндоплазматического матрикса. В качестве диагностических тест-систем исследователи ориентируют на применение остеокальцина, PICP/PINP и CTР, а также производных коллагена I типа: PYD, DPD, NTX, CTX. Таким образом, в обзоре раскрыты наиболее перспективные в плане мониторинга маркеры репаративных процессов костной ткани пропептиды проколлагена I типа (PICP). Известное клиническое значение также имеет определение активности костного изофермента щелочной фосфатазы и уровня остеокальцина. Одним из наиболее чувствительных методов оценки состояния костной резорбции является сывороточный С-терминальный телопептид коллагена I типа. Значимым маркером активации остеолизиса представляется костный сиалопротеин. Высокой специфичностью при оценке деструктивных процессов обладает катепсин К — основной протеолитический фермент остеокластов. Интересными в контексте оценки метаболизма собственно матрикса являются пиридинолин (PYD) и деоксипиридинолин (DPD). Раннее выявление метаболических нарушений дает возможность проведения своевременной коррекции состояния и проведению адекватного лечения.
Annotation
In the spectrum of purulent-inflammatory diseases of the maxillofacial region, one of the most severe, sluggish complications of odontogenic and traumatic nosologies is osteomyelitis of the jaw, the proportion of which, according to various authors, reaches 30%. The actual pathogenetic mechanism of the formation of chronic osteomyelitis of the jaw, according to modern concepts, is a violation of bone metabolism, mediated by the influence of pathogenic microflora and microcirculation disorders. The review describes the possibilities of using markers of bone tissue metabolism to predict the course of the disease and the effectiveness of the therapy.The search work was carried out using international scientific databases PubMed, ScienceDirect, Scopus, Cochrane Collaboration, Elsevier, as well as electronic catalogs of the Central Scientific Medical Library of the Russian Federation, libraries http://elibrary.ru and http://cyberleninka.ru. The data presented reflect the most informative biomarkers for assessing the remodeling of the endoplasmic matrix. As diagnostic test systems, researchers focus on the use of osteocalcin, PICP/PINP and CTP, as well as type I collagen derivatives: PYD, DPD, NTX, CTX. Thus, the review discloses the most promising markers of bone tissue reparative processes in terms of monitoring, type I procollagen propeptides (PICP). Determination of the activity of the bone isoenzyme of alkaline phosphatase and the level of osteocalcin is also of known clinical importance. One of the most sensitive methods for assessing the state of bone resorption is the serum C-terminal telopeptide of type I collagen. Bone sialoprotein is a significant marker of osteolysis activation. Cathepsin K, the main proteolytic enzyme of osteoclasts, is characterized by high specificity in assessing destructive processes. Of interest in the context of assessing the metabolism of the matrix itself are pyridinoline (PYD) and deoxypyridinoline (DPD). Early detection of metabolic disorders makes it possible to carry out timely correction of the condition and conduct adequate treatment.
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