ymjЯкутский медицинский журналYakut Medical Journal1813-19052312-1017ЯНЦ КМП10.1234/YMJ.2022.77.25ymj-167Research ArticleНАУЧНЫЕ ОБЗОРЫ И ЛЕКЦИИSCIENTIFIC REVIEWS AND LECTURESВлияние физических стрессоров на нейроэндокринный ответ у пациентов в критическом состоянииEffect of physical stressors on neuroendocrine response in critically ill patientshttps://orcid.org/0000-0001-5646-0055АльтшулерН. Э.AltshullerN. E.

Альтшулер Натаван Эльшад – к.м.н., врач-эндокринолог, врач анестезиолог-реаниматолог.

Москва

Natavan E. Altshuller – MD, endocrinologist, anesthesiologist.

Moscow

natavan.altschuler@gmail.comhttps://orcid.org/0000-0003-0193-5732АлещенкоЕ. И.AleschenkoE. I.

Алещенко Елена Игоревна – к.м.н., врач анестезиолог-реаниматолог, зав. отделением.

Москва

Elena I. Aleschenko – MD, anesthesiologist and intensive care specialist, head of the department.

Moscow

https://orcid.org/0000-0003-0096-905XКуцыйМ. Б.KutcyiM. B.

Куцый Михаил Борисович – к.м.н., врач анестезиолог-реаниматолог, руковод. Операционного центра.

Москва

Mikhail B. Kutcyi – MD, anesthesiologist, supervisor of the operation center.

Moscow

https://orcid.org/0000-0001-5011-6288КругляковН. М.KruglyakovN. M.

Кругляков Николай Михайлович – врач анестезиолог-реаниматолог, зав. отделением.

Москва

Nikolay M. Kruglyakov – anesthesiologist, head of the department, the State Scientific Research Center of the Russian Federation, Burnazyan Federal Medical Biophysical Centre of Federal Medical Biological Agency.

Moscow

АО «Европейский медицинский центр»Russian FederationГосударственный НЦ Российской Федерации-Федеральный медицинский биофизич. центр им. А.И. БурназянаРоссияState Scientific Research Center of the Russian Federation, Burnazyan Federal Medical Biophysical Centre of Federal Medical Biological AgencyRussian Federation2022050220250199104Copyright © Альтшулер Н.Э., Алещенко Е.И., Куцый М.Б., Кругляков Н.М., 20252025Альтшулер Н.Э., Алещенко Е.И., Куцый М.Б., Кругляков Н.М.Altshuller N.E., Aleschenko E.I., Kutcyi M.B., Kruglyakov N.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://ymj.elpub.ru/jour/article/view/167

Взаимосвязь между иммунной системой и ЦНС при воздействии стрессоров приводит к стереотипным ответам, включающим в себя вегетативные, эндокринные и поведенческие компоненты. Но, несмотря на крайне важную роль нейроэндокринных факторов в реализации критических состояний, детально их значение, а также показания и меры воздействия на них до сих пор не изучены. Дальнейшее изучение и создание концепции об эндокринопатиях критических состояний в перспективе может стать основанием для оценки эндокринного статуса пациента с целью принятия решения о необходимости проведения заместительной терапии.

A critical condition is a complex of changes that require replacement of the functions of vital organs and systems to prevent death. The set of reactions can be considered as a gradual development of physiological and pathological reactivity. The most important role in the formation of reactivity in critical conditions is played by the neuroendocrine and neuroimmune systems. The concept of the neuroendocrine system includes connections between the endocrine and central nervous systems and their relationship in the control of homeostasis. Stimulation of the immune system to a complex neuroimmunoendocrine interaction in order to avoid development of a critical condition. Cytokines and afferent pathways of the vagus nerve activate the hypothalamic-pituitary-adrenal system, as a result of which the increased secretion of glucocorticoids suppresses the activity of the immune system. The main action of thyroid hormones is manifested at the genomic level by stimulating the synthesis of many structural proteins of the body and suppressing the expression of neuronal NOS. The sympathetic link of the autonomic nervous system leads to a decrease in the release of pro-inflammatory cytokines, while the synthesis of anti-inflammatory cytokines does not change. In turn, glucocorticoids have a powerful anti-inflammatory effect by reducing the transcription of cytokines by suppressing the nuclear factor "kappa-bi" - a universal transcription factor that controls the expression of genes for the immune response, apoptosis and the cell cycle. At the same time, in critical conditions, a high level of cortisol is observed against the background of a suppressed level of ACTH. This fact is explained by glucocorticoid resistance.

The relationship between the immune system and the central nervous system when exposed to stressors leads to stereotyped responses that include autonomic, endocrine and behavioral components. But despite the extremely important role of neuroendocrine factors in the implementation of critical conditions, their significance, as well as indications and measures of influence on them, have not yet been studied in detail. Further study and the concept of endocrinopathies of critical conditions in the future will be the basis for assessing the endocrine status in order to resolve the issue of the need for substitution therapy.

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The authors declare that there are no conflicts of interest present.